Thoracoscopy

Question 1

Describe a video-assisted thoracoscopy.

Answer 1

The patient is typically placed in the lateral position. The video
thoracoscope is inserted into a small incision so that the pleural
cavity can be assessed. Several other small incisions are then
made for the insertion of instruments. The instruments and the
thoracoscope can be interchanged based upon the location of
the problem.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 326.

Question 2

What are the common preop diagnoses seen in
patients presenting for Video-Assisted
Thoracoscopic Surgery (VATS)?

Answer 2

Recurrent empyema, recurrent pneumothorax, pleural effusions,
localized lung masses, pulmonary infiltrates, achalasia,
hyperhidrosis, reflex sympathetic dystrophy (RSD)
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 326.

Question 3

List ways in which VATS are used.

Answer 3

VATS are used to treat spontaneous pneumothorax caused by
apical blebs, talc pleurodesis, peripheral infiltrate or nodule
biopsies, drainage of pleural effusions or other collections of
fluid, evaluation and evacuation of traumatic hemothorax, early
empyema decortication, standard lung resections, lung-volume
reduction surgery, and for the removal of some small tumors
and cysts. They can also be used for nonthoracic procedures
such as minimally invasive cardiac surgery, pericardial window,
and sympathectomy.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 326.

Question 4

Is the use of a double lumen tube necessary with a

VATS? Why or why not?

Answer 4

Yes. A double lumen tube must be used so that the ipsilateral
lung is collapsed and proper visualization of the pleural cavity is
achieved.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 326.

Question 5

What are potential complications of a VATS.

Answer 5

Hemorrhage, air embolism, air leak from lung, damage to
intrathoracic structures
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 326.