Video-Assisted Thoracoscopic Surgery (VATS) for Lung Surgery with Small Incisions Without Intubation

The lungs are organs in the respiratory system responsible for exchanging oxygen and carbon dioxide with the blood. The lung structure consists of bronchi, lung tissue, alveoli, and capillaries. If these structures become severely abnormal and cannot be cured with medication or other treatments, doctors will consider surgical treatment.

Types of Lung Surgery

Lung surgery involves removing part or all of the lung tissue that has lesions or abnormalities. The main goal is to preserve as much lung function as possible to ensure a good quality of life for the patient and reduce complications.

Surgery can be performed as open thoracotomy, which is the traditional method, or video-assisted thoracoscopic surgery (VATS or Uniportal VATS), which is currently popular because it causes less pain and allows faster recovery. Generally, the type of lung surgery depends on the location and size of the tissue to be removed, as follows:

Removing only a small part of the lung, such as wedge resection or segmentectomy, usually used for small lesions or for diagnostic purposes.

Lobectomy, which is the removal of an entire lobe of the lung. This is a common method for treating early-stage lung cancer by removing the entire lobe containing the tumor.

Pneumonectomy, which is the removal of an entire lung. This is usually done when the lesion is very large or has spread throughout the lung.

Removing a lobe of the lung along with the involved bronchus and then reconnecting the remaining bronchus to preserve as much lung tissue as possible. This is a complex technique used when cancer invades the main bronchus.

Video-Assisted Thoracoscopic Surgery (VATS) and Lung Disease Treatment

The decision to perform lung surgery is complex. Doctors evaluate many factors, including the type of disease, severity stage, overall patient health, and risks associated with surgery to ensure the surgery provides the maximum benefit to the patient, such as:

Early-stage lung cancer (stages 1 and 2) offers effectiveness comparable to open surgery in removing cancer cells. Surgery focuses on removing the lung lobe containing the tumor along with the related lymph nodes to ensure complete cancer cell removal.

Lung nodules where VATS is an option for biopsy to send tissue for laboratory examination or to remove the entire nodule if suspected malignant or causing symptoms affecting quality of life. VATS allows surgeons to clearly see and precisely remove the nodule without large incisions.

Pneumothorax causing lung collapse. Surgeons use VATS to locate and remove abnormal blebs causing air leaks. This is often done in patients with frequent recurrences or severe air leaks, helping relieve chest pain and breathing difficulties.

Pleural infections such as empyema where antibiotics or drainage are insufficient. Surgery helps drain pus and infected tissue thoroughly and cleans the pleural cavity, allowing the lung to fully re-expand.

Other thoracic tumors such as thymoma located in front of the heart, which is very beneficial for patients with myasthenia gravis related to thymic tumors.

However, VATS has limitations in cases of advanced disease, such as advanced or metastatic lung cancer, malignant pleural mesothelioma, or chronic pleural infections with extensive fibrosis. In these cases, traditional open surgery may be necessary. Also, if the tumor is too large, VATS may be more difficult to perform.

Video-Assisted Thoracoscopic Surgery (VATS) to Uniportal VATS Single Incision Technique

Video-assisted thoracoscopic surgery (VATS) is a technique for lung or other thoracic disease surgery where surgeons use a small video camera along with surgical instruments inserted into the chest through small incisions about 2–3 centimeters in size, with 1-3 incisions on the chest wall.

This technique allows surgeons to clearly see the internal organs of the chest on a monitor without needing a large incision like traditional thoracotomy, resulting in less postoperative pain, shorter recovery time, and fewer complications such as nerve injury or surgical wound pain.

In the past, VATS required multiple incisions for the camera and surgical instruments, but now it has evolved into the Uniportal VATS technique, which uses only one incision, reducing tissue trauma and impact on the patient’s body.

Understanding Video-Assisted Thoracoscopic Surgery (VATS) Without Intubation (Non-intubated VATS)

Non-intubated VATS is a thoracic surgery technique where the patient receives local anesthesia at the surgical site and light sedation to relax while maintaining natural breathing. This reduces risks associated with intubation and full general anesthesia.

During surgery, the lung on the operated side naturally collapses due to gravity and chest pressure, providing surgeons with sufficient space to see and work without the need for muscle relaxants, which can affect the patient’s respiratory system.

However, this technique is suitable for patients with good respiratory function, no complex complications, and must be performed by a highly skilled medical team. If unexpected complications occur during surgery, the team can immediately switch to intubation and general anesthesia for the patient’s safety, which is the most important principle in all surgeries.

Advantages of Non-intubated Video-Assisted Thoracoscopic Surgery (Non-intubated VATS)

Non-intubated VATS is a developed technique to reduce the burden and risks of surgery in lung and thoracic patients compared to intubated surgery, with the following benefits:

Reduces risks and side effects from intubation such as injury to the trachea and larynx, sore throat, and hoarseness, which are common side effects after intubation.

Reduces side effects from anesthesia such as nausea and vomiting, leading to smoother recovery.

Faster recovery with shorter hospital stays; many patients can walk within hours after surgery.

Reduces the need for postoperative mechanical ventilation because the lungs and airways are not disturbed by intubation. Most patients can breathe effectively immediately after surgery. Avoiding mechanical ventilation reduces the risk of pneumonia and other ventilation-related complications.

Reduces the risk of pulmonary complications in the elderly who often have other comorbidities. Intubation and full anesthesia may increase the risk of pulmonary complications such as pneumonia or respiratory failure.

Non-intubated VATS is therefore a minimally invasive surgical technique that not only reduces the size of the surgical wound but also lessens the impact on the respiratory system and other body systems, providing patients with a better surgical experience, faster recovery, and improved quality of life after treatment. However, this technique is not suitable for all patients.

If you or someone close to you is at risk or has symptoms similar to lung disease, such as chronic cough, difficulty breathing, or even a detected lung nodule, thorough diagnosis will help in planning better and more effective treatment.

At Phyathai 2 Hospital, we have a highly experienced team of thoracic and lung specialists, equipped with modern technology and tools, from diagnosis to surgery, including video-assisted thoracoscopic surgery (VATS) and non-intubated VATS. We adhere to the Value Healthcare principle, allowing you to choose private nursing, preferred meals, and suitable rooms to meet both value and health quality tailored truly to you.

Assoc. Prof. Dr. Sira Laothai

Thoracic Surgeon specializing in Video-Assisted Thoracoscopic Surgery of the Lungs and Thymus

Video-Assisted Thoracoscopic Surgery (VATS), minimally invasive lung surgery without intubation