Thoracic surgery has seen many changes over the years. Mr Niall McGonigle, consultant thoracic surgeon, discusses the benefits of video assisted thoracic surgery (VATS) and how this is used to treat multiple conditions and health problems.
Minimally invasive thoracic surgery has many advantages over open lung surgery, including: reduced hospital stay, quicker recovery and reduced postoperative pain.
Video assisted thoracic, or thoracoscopic, surgery (VATS) is performed using small incisions in the skin and inserting plastic ports to allow a camera, and other specially designed surgical instruments, to be inserted into the chest. This so-called ‘keyhole’ procedure is different to previous procedures, which typically required much larger incisions and spreading or removal of ribs.
Today, operations for lung cancer requiring removal of a lung lobe, or even of the entire lung, can be performed this way and VATS is regularly performed for secondary tumours that have spread to the lungs from other cancers.
Unfortunately, many patients with cancers affecting the chest can develop fluid around the lung which makes the patient short of breath. However, this fluid can easily be drained by VATS and chemical agents, such as talc or iodine, instilled into the chest between the lung and the chest wall. This causes the lung to ‘stick’ to the lining of the inside of the chest, preventing further re-accumulation of fluid, therefore allowing patients to breath more easily.
Biopsy of masses in the lung, pleura (lining of chest wall) and the mediastinum (centre of the chest) are virtually always now carried out by keyhole and frequently, rather than just biopsying the mass, the entire mass is removed within the same operation in what is called an excisional biopsy.
However, VATS surgery is not just for cancer or suspected cancer, and most patients with recurrent pneumothorax (collapsed lung) or emphysema can be treated using VATS, significantly reducing the chances of recurrence of this problem.
Most patients having this surgery simply want to avoid a further pneumothorax but occasionally we perform this operation for people working in professions where a collapsed lung can have very serious consequences, such as airline pilots and divers.
We can also help patients with problems of excessive sweating or facial blushing by performing surgery through two very small incisions in the axilla (armpit) and performing a sympathectomy (dividing nerves within the chest), helping to alleviate these troublesome and often quite distressing symptoms with very good results. There are, however, limitations to VATS when it comes to complicated operations and extended resections for advanced lung cancer. These procedures are therefore carried out using the traditional ‘open’ technique.
Consultant thoracic surgeons who currently offer VATS treatment at Royal Brompton and Harefield hospitals include:
- Professor Vladimir Anikin
- Mr Nizar Asadi
- Miss Emma Beddow
- Mr Michael Dusmet
- Mr Simon Jordan
- Professor Eric Lim.
Mr Niall McGonigle returned to his native Belfast in 2017, after five years as a consultant thoracic surgeon at Harefield Hospital and clinical chair for lung cancer.