Understanding Thoracoscopy

Video-Assisted Thoracoscopic Surgery (VATS) is a surgical procedure where 1-3 small incisions are made in your chest wall. A scope is inserted into the chest cavity so the surgeon can directly visualize the lining of the chest wall and the surface of the lungs. A biopsy can then be obtained to help with your diagnosis. A part of the lung may be removed in order to treat your disease. (If the entire lung has to be removed, your doctor will need to make a much bigger incision to safely remove the lung.) This procedure requires general anesthesia and the insertion of a chest tube, which reinflates the lung after the procedure is done. You will remain in the hospital for 1-5 days after your surgery. Your doctor may know the preliminary results of the procedure on the same day as the surgery. The final pathology report will take up to 3-5 working days, and will be reviewed with you when you are in the hospital or when you return for a postoperative visit.

How to Prepare for Your Procedure

Many medications, whether over-the-counter or prescription, can interfere with normal blood clotting and increase the risk of bleeding. Follow the guidelines in the chart below. If your doctor gives you different instructions, always follow your doctor’s instructions.

7 days before your procedure, STOP:

  • Aspirin
  • vitamins
  • herbal & garlic supplements
  • Plavix® (clopidogrel)

5 days before your procedure, STOP:

  • Coumadin® (warfarin)

3 days before your procedure, STOP:

All nonsteroidal antiinflammatory medications (NSAIDs):

  • Advil® or Motrin® (ibuprofen)
  • Aleve® or Anaprox® (naproxen)
  • Feldene® (piroxicam)
  • Clinoril® (sulindac)
  • Orudis® (ketoprofen)

2 days (48 hrs) before your procedure, STOP:

  • Fragmin® (dalteparin)
  • Arixtra® (fondaparinux)

1 day (24 hrs) before your procedure, STOP:

  • Lovenox® (enoxaparin)

DO NOT eat or drink after midnight the night before the surgery; this includes gum, candy, lollipops, water, coffee, juice, etc.

What to Expect On the Day of Your Procedure

  • On the day of your surgery, take only the medications approved by your anesthesiologist, with a sip of water. If you are unsure of these medications please contact the Thoracic Center for an explanation at (716) 845-1411.
  • The morning of your surgery you will check in at Patient Access (registration) on the ground floor in the hospital lobby. You will then be directed to 3 West.
  • An intravenous catheter (IV) will be placed in a vein in your arm so that medications and fluids can be given to you for the procedure.
  • You will be taken to a “holding area” which is located just outside the operating room. The anesthesiologist will meet you there before you are taken into the operating room. Your family will not be able to join you in the holding area.

What You Can Expect After Your Procedure

  • You may be in intensive care (ICU) for the first 24-48 hours. You will then be transferred to a general surgical floor.
  • In the ICU you will be attached to a cardiac monitor that shows your heart rate and rhythm, blood pressure, and oxygenation level.
  • You will have a chest tube in your side for at least 48-72 hours, longer if necessary. Sometimes there is an “air leak” in the lung tissue that may delay removal of the chest tube. Your chest tube will be removed as soon as your lung has fully expanded and air does not leak from the lung.
  • You may have pain from the incisions and chest tube. You will receive pain medication through an intravenous (IV), orally, and through the chest tube.
  • You will need to do coughing and deep breathing exercises to prevent you from developing pneumonia after surgery. The nurses and respiratory therapists will show you how to perform these exercises using an “incentive spirometer.” It is VERY important that you cough up secretions and take deep breaths to prevent pneumonia. We will take chest x-rays to monitor you. • You will be at risk for developing blood clots in your legs. You will wear plastic stockings around your legs that inflate and deflate periodically to keep the blood moving so blood clots do not form. You will also be on a mild blood thinner to prevent clots. • You need to walk as early as possible to prevent blood clots from developing, to help get your bowels working again, and to exercises your lungs. Your ability to get around helps us determine when you can safely go home.

What to Expect When You Are Discharged

  • You will be given additional instructions when you are discharged.
  • You may be discharged with oxygen. This may be temporary or permanent and cannot be determined until after the surgery.
  • You may shower, unless instructed otherwise. Raising your arms over your head, such as to wash your hair, may cause fatigue, shortness of breath, or pain. You may need someone to help you. Do not scrub the incisions. Allow soap and water to run over the incisions. Pat them dry.
  • Keep your incisions clean and dry. Leave them open to air as much as possible, as this promotes healing. Restrictive clothing, such as a bra, may irritate your incision.
  • The chest tube site may drain straw-colored (yellow) or slightly bloody drainage. This is normal. You can protect your clothing by covering the incision with gauze until it dries up.
  • You will be sent home with pain medications. Pain medication can be constipating and you may need a stool softener while you are on the pain medications. Let your doctor know if constipation is a problem.
  • If you have stitches, they will be removed when you return for a postoperative visit.
  • You may not drive until your doctor gives you the OK. You should have someone with you the first time you do drive. Pain may prevent you from being able to turn your head to drive safely.
  • You may do physical activity as tolerated. Heavy lifting for the first 1-2 weeks will not harm you, but may irritate your incisions and cause increased pain.
  • No flying for one (1) month.
  • You will be seen for a postoperative Center visit 1-2 weeks after the surgery.

What to Report to Your Physician

Call your doctor immediately if you have:

  • Increased shortness of breath or increased difficulty breathing
  • Chest pain
  • Fever off 100.5°F (38°C) or higher
  • Increased redness, drainage, or swelling around the incisions or chest tube sites
  • Pus-like or foul smelling drainage from incisions
  • A bubbling or sucking sound from an incision

Questions or Concerns

Call the Thoracic Center at  716 845-1411 if you have any problems or questions. The Center is open Mon - Fri from 8:00 am to 4:30 pm. During evenings, weekends, and holidays, please call the main hospital at  716 845-2300 and ask for the thoracic surgeon on call.