Video-Assisted Thoracoscopic Surgery (VATS)

Updated: Mar 17, 2021
  • Author: Doraid Jarrar, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Video-assisted thoracoscopic surgery (VATS) is minimally invasive thoracic surgery that does not use a formal thoracotomy incision. VATS provides adequate visualization despite limited access to the thorax, allowing the procedure to be performed in patients who are debilitated or have marginal pulmonary reserve. [1]

VATS is principally employed in the management of pulmonary, mediastinal, and pleural pathology. Its main benefit has been the avoidance of a thoracotomy incision, which allows a shorter operating time, less postoperative morbidity, and earlier return to normal activity than can be achieved with thoracotomy.

The first clinical application of VATS dates back to 1913, when adhesiolysis was performed to enhance pneumothorax therapy of tuberculosis via a cystoscope introduced into the pleural cavity. [1] VATS is now an established and widely used minimally invasive approach to diseases of the chest.

Compared with conventional thoracotomy, VATS lobectomy has resulted in better preservation of pulmonary function. [2] In addition, overall surgical mortality is 0-2% for VATS, which compares favorably with mortality for the conventional thoracotomy technique. [3, 4]



VATS is used in both diagnostic and therapeutic pleural, lung, and mediastinal surgery. Specific indications include the following:

  • Stapled lung biopsy
  • Lobectomy or pneumonectomy
  • Resection of peripheral pulmonary nodule
  • Evaluation of mediastinal tumors or adenopathy
  • Pleural biopsy
  • Bullectomy
  • Treatment of recurrent pneumothorax
  • Management of loculated empyema
  • Pleurodesis of malignant effusions
  • Repair of a bronchopleural fistula
  • Chest trauma (mainly diaphragmatic injuries)
  • Pericardial window
  • Sympathectomy
  • Truncal vagotomy

Although the use of thoracoscopy for pulmonary metastesectomy has been controversial, some authors have found it to be efficacious and safe. [5, 6]

The use of VATS to accomplish cardiac denervation of refractory ventricular arrhythmias and electrical storms has been described. [7]



Absolute contraindications include the following:

  • Markedly unstable or shocked patient
  • Extensive adhesions obliterating the pleural space
  • Prior talc pleurodesis

Relative contraindications include the following:

  • Inability to tolerate single-lung ventilation
  • Previous  thoracotomies
  • Extensive pleural diseases
  • Coagulopathy
  • Prior radiation treatment for thoracic malignancy; plan to resect


In a prospective observational study evaluating long-term survival outcomes of VATS lobectomy with lymphadenectomy in 109 patients with non-small cell lung cancer who were followed for a median of 27 months, Luan et al reported overall survival rates of 100% after 1 year, 85.9% after 2 years, 65.3% after 3 years, 55.9% after 4 years, and 55.9% after 5 years. [8]