Video-Assisted Thoracoscopic Surgery (VATS)

Updated: Mar 17, 2023
  • 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, which allows a shorter operating time, less postoperative morbidity, and earlier return to normal activity than can be achieved with a 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:

Although the use of thoracoscopy for pulmonary metastesectomy has been controversial, some authors have found it to be efficacious and safe. [6, 7]  In a survey carried out by the European Society of Thoracic Surgeons (ESTS), 72% of respondents preferred a minimally invasive approach to metastasectomy for pulmonary metastases in colorectal cancer patients. [8]

The use of VATS to accomplish cardiac denervation of refractory ventricular arrhythmias and electrical storms has been described. [9]



Absolute contraindications include the following:

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

Relative contraindications include the following:



In a prospective observational study evaluating long-term survival outcomes of VATS lobectomy with lymphadenectomy in 109 patients with non-small cell lung cancer (NSCLC) 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. [10]