Study of diagnostic and therapeutic utility of video assisted thoracoscopic surgery


  • Nilesh P. Mangam Department of Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
  • Aashish R. Chavan Department of Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
  • Ritesh Bodade Department of Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India
  • Asmita Dhurve Department of Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India



Chest pathology, Lung hydatid disease, Pleural empyema, Radiological investigation, Video-assisted thoracoscopic surgery


Background: Video-assisted thoracoscopic surgery (VATS) is rapidly becoming a popular method for diagnostic and therapeutic purposes. Many diseases of the chest can now be diagnosed by VATS due to ease of look and biopsy. Hence the present study was undertaken to determine diagnostic and therapeutic utility of VATS in different chest pathologies.

Methods: In this prospective study, total 36 patients of different age group were subjected to VATS procedure, to measured operative time, intra and post- operative complications, post-operative pain and hospital stay. Then patient was followed up at 15 days, at 1 month, 3 month and at 6 months.

Results: VATS was successfully carried out in 28 patients as the only procedure whereas 8 patients required conversion to thoracotomy. Average operative time for patients operated by VATS only was 94.9 minute and for patients operated by VATS converted to thoracotomy was 175.5 minute. Most common intraoperative complication was bleeding (16.66 %) followed by anaphylactic shock observed in only one patient. Most common postoperative complication was prolonged air leak (5.55%) followed by port site infection (2.77%) and postoperative bleeding (2.77%). At 24 hours postoperatively, average pain score observed in VATS group was 3.73 and in thoracotomy group was 6.28. The mean postoperative hospital stay for patients operated by VATS was 7.28 days and for patients operated by VATS converted to thoracotomy was 10.36 days. There was significant difference observed in diagnosis of various chest pathologies by radiological investigations and VATS.

Conclusions: VATS should be offered as the first approach to various chest pathologies requiring surgical intervention and preferred over thoracotomy when feasible. 


Available at

Prasad A. Video-assisted thoracoscopic surgery (VATS). 27;229-238.

Jay B. Brodsky and Edmond Cohen. Video-assisted thoracoscopic surgery. Curr Opin Anaesthesiol 13:000-000. 2000 Lippincott Williams & Wilkins.

Courtney Broaddus V, Richard WL. Thoracoscopy or Video-Assisted Thoracic Surgery, in Murray and Nadel's Textbook of Respiratory Medicine (Sixth Edition), 2016.

McFadden PM. Minimally Invasive Thoracic Surgery. Ochsner J. 2000;2(3):137-44.

Available at

Оkhunov АО. Chair of general and pediatric surgery. electronic Textbook. Available at

Ghoshal AG, Sarkar S, Saha K, Sarkar U, Kundu S, Chatterjee S, Kundu S. Hydatid lung disease: an analysis of five years cumulative data from Kolkata. J Assoc Physicians India. 2012;60(7):12-6.

Dakak M, Genç ON, Gürkök S, Gözübüyük A, Balkanli K. Surgical treatment for pulmonary hydatidosis (a review of 422 cases). Journal of the Royal Coll Surg Edinburgh. 2002;47(5):689-92.

Pappalardo E, Laungani A, Demarche M, Erpicum P. Early thoracoscopy for the management of empyema in children. Acta Belgian Surgical. 2009;109(5):602-5.

Jancovici R, Lang-Lazdunski L, Pons F, Cador L, Dujon A, Dahan M, Azorin J. Complications of video-assisted thoracic surgery: a five-year experience. Ann Thoracic Surgery. 1996;61(2):533-7.

Kadkhodaei H, Sahba Z. The role of Thoracoscopy in the management of hydatid cyst of lung. International Society for minimally invasive cardiothoracic surgery, EP.2011. 122.

Jakubowski MS, Barnard DE. Anaphylactic shock during operation for hydatid disease, Anesthesiology. 1971;34: 197-99.

Podbielski FJ, Maniar HS, Rodriguez HE, Hernan MJ, Vigneswaran WT. Surgical strategy of complex empyema thoracis. JSLS: J Society Laparoendoscopic Surgeons. 2000;4(4):287-90.

Grewal H, Jackson RJ, Wagner CW, Smith SD. Early video-assisted thoracic surgery in the management of empyema. Pediatrics. 1999;103(5):e63.

Alpay L, Lacin T, Atinkaya C, Kıral H, Demir M, Baysungur V, et al. Video-assisted thoracoscopic removal of pulmonary hydatid cysts. Eur J Cardio-Thoracic Surgery. 2012;42(6):971-5.

Oak SN, Parelkar SV, Satishkumar KV, Pathak R, Ramesh BH, Sudhir S, Keshav M. Review of video-assisted thoracoscopy in children. J Minimal Access Surg. 2009;5(3):57.

Muhammad MI. Management of complicated parapneumonic effusion and empyema using different treatment modalities. Asian Cardiovas Thoracic Ann. 2012;20(2):177-81.

Freeman RK, Wozniak TC, Fitzgerald EB. Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thoracic Surg. 2006;81(5):1853-7.

Parelkar SV, Oak SN, Patel JL, Sanghvi BV, Joshi PB, Sahoo SK, Sampat N. Traumatic diaphragmatic hernia: Management by video assisted thoracoscopic repair. J Indian Ass ediatr Surg. 2012;17(4):180-3.

Collard JM, Lengele B, Otte JB, Kestens PJ. En bloc and standard esophagectomies by thoracoscopy. Ann Thoracic Surgery. 1993;56(3):675-9.

Liu N, Gilkeson R, Markowitz A, Schröder C. Thoracoscopic removal of a suture needle from the posterior pericardium after coronary artery bypass grafting. Interactive Cardiovasc Thoracic Surg. 2011;13(3):341-3.

Dominioni L, Dionigi R. Masson III edition; 2002;857-936.

Kaiser LR. Video-assisted thoracic surgery: current state of art. Anna Surgery 1994; 220:720-34.

Hazelrigg SR, Magee MJ, Cetindag IB. Video-assisted thoracic surgery for diagnosis of the solitary lung nodule. Chest Surg Clin North America. 1998;8(4):763-4.

Tschemko EM, Hofer S, Bieglmayer C, Wisser W, Haider W. Early postoperative stress: video-assisted wedge resection/lobectomy vs conventional axillary thoracotomy. Chest. 1996;109(6):1636-42.

Cassina PC, Hauser M, Hillejan L, Greschuchna D, Stamatis G. Video-assisted thoracoscopy in the treatment of pleural empyema: stage-based management and outcome. J Thoracic Cardiovas Surg. 1999;117(2):234-8.

Mehta KD, Gundappa R, Contractor R, Sangani V, Pathak A, Chawda P. Comparative evaluation of thoracoscopy versus thoracotomy in the management of lung hydatid disease. World J Surg. 2010;34(8):1828-31.

Shivachev KH, Brankov O, Drebov R et al. Contemporary treatment of parapneumonic pleural complication in children: the role of Video - Assisted Thoracoscopic Surgery (VATS), Khirurgiia (Sofiia) 2007;(3):14-8.

Mouroux J, Venissac N, Leo F, Alifano M, Guillot F. Surgical treatment of diaphragmatic eventration using video-assisted thoracic surgery: a prospective study. Ann Thoracic Surgery. 2005;79(1):308-12.

Yen MH, Hung SH, Huang CS et al. Esophagectomies for Esophageal Cancer: Video-Assisted Thoracoscopic Surgery (VATS) Versus a Traditional Thoracotomy, Fu-Jen J Med 2011;9(1):23-29.

Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, Landreneau RJ. Minimally invasive operation for esophageal diverticula. Ann Thoracic Surg. 2005;80(6):2076-80.

Varghese Jr TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thoracic Surg. 2007;84(6):1801-9.

Shahin Y, Duffy J, Beggs D, Black E, Majewski A. Surgical management of primary empyema of the pleural cavity: outcome of 81 patients. Interactive Cardiovas Thoracic Surgery. 2010;10(4):565-7.

Laisaar T, Palmiste V, Vooder T, Umbleja T. Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis. Interactive Cardiovasc Thoracic Surg. 2006;5(3):307-10.

Khanday ZS, Deepak J, Bagdi RK, Balagopal AP, Madhu B. Video-assisted thoracic surgery in children: our institutional experience. Sri Ramachandra J of Med. 2009;1:45-8.

Freeman RK, Al-Dossari G, Hutcheson KA, Huber L, Jessen ME, Meyer DM, et al. Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma. Ann Thoracic Surg. 2001;72(2):342-7.

Wu B, Xue L, Qiu M, Zheng X, Zhong L, Qin X, et al. Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy for esophageal cancer. J Cardiothoracic Surg. 2010;5(1):132.

Dinka T, Kovács O, Kotsis L. Emergency video-assisted thoracoscopic surgery for intrathoracic foreign bodies. Magyar Sebeszet. 2004;57(6):346-50.






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