How do I prepare for the test?
We will discuss the specific procedures planned during your chest surgery ahead of time. You will need to sign a consent form giving the surgeon permission to perform this test.
You may need to have tests called pulmonary function tests before this surgery, to make sure that you can recover well.
If you are taking insulin, discuss this before the test. Tell us if you take aspirin, coumedin, plavix nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test.
You will be told not to eat anything after midnight the day before the surgery. An empty stomach helps prevent the nausea that can be a side effect of anesthesia medicines.
Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.
What happens when the test is performed?
VATS is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
VATS is done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. Your anesthesiologist can use this tube to make you breathe using only one of your lungs. This way the other lung can be completely deflated and allow the surgeon a full view of your chest cavity on that side during the procedure.
You spend the surgery lying on your side. A very small incision (less than an inch long) is made, usually between your seventh and eighth ribs. Your lung on that side is made to partly or completely collapse. A tiny camera on a tube, called a thoracoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen.
If you are having a procedure more complicated than inspection of the chest and lung, the doctor makes one or two other small incisions to allow additional instruments to reach into your chest. A wide variety of instruments are useful in VATS. These include instruments that can cut away a section of your lung and seal the hole left in your lung using small staples, instruments that can burn away scar tissue, and tools to remove small biopsy samples such as lymph nodes from your chest.
At the end of your surgery, the instruments are removed, the lung is reinflated, and all but one of the small incisions are stitched closed. For most patients, one or two tubes (called chest tubes) are placed through the remaining openings to help drain any leaking air or fluid that collects after the surgery.
If you are having general anesthesia, it is stopped so that you can wake up within a few minutes of your VATS being finished, although you will remain drowsy for a while afterward.
What risks are there from the test?
It is easier for patients to recover from VATS compared with regular chest surgery (often called "open" surgery) because the wounds from the incisions are much smaller. You will have a small straight scar (less than an inch long) wherever the instruments were inserted. There are some potentially serious risks from VATS surgery. Air leaks from the lung that don't heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. About 1% of patients have significant bleeding requiring a transfusion or larger operation.
Sometimes, especially if cancer is diagnosed, your doctors will decide that you need a larger surgery to treat your problem in the safest manner possible. Your doctors might discuss this option with you ahead of time. That way, if necessary, the doctors can change over to a larger incision and do open chest surgery while you are still under anesthesia. Death from complications of VATS surgery does occur in rare cases, but less frequently than with open chest surgery.
Must I do anything special after the test is over?
Most patients stay in the hospital for several days after a VATS procedure to recover from the surgery. Most patients have chest tubes left in the chest for a few days, to help drain out leaking air or collections of fluid.
How long is it before the result of the test is known?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.
