Stephen R. Hazelrigg, MD, Traves D. Crabtree, MD, Michael J. Thomas, MD, Philipos K. Gebremedhin

Key Points

  • Video-assisted thoracic surgery (VATS) is useful for undiagnosed exudative pleural effusions to rule out malignancy.
  • VATS is very effective for empyema before the chronic fibrous phase, which occurs after 3-4 weeks.
  • VATS wedge resection for peripheral nodules provides definitive diagnosis.
  • VATS lobectomy appears safe and comparable to open lobectomy when done by experienced thoracic surgeons.
  • Lung volume reduction study may be done by VATS or sternotomy with comparative long-term outcome results in regard to lung function, 6-minute walk, and oxygen requirements.
  • VATS sympathectomy approaches 100% success for palmar hyperhidrosis.
  • VATS pericardectomy may provide advantages over a subxiphoid approach when the cause is benign; for malignant sources, the subxiphoid route is typically preferred.


Thoracoscopy has emerged as a frequently used surgical technique over the past three decades. Before 1990, its utility was largely reserved as a diagnostic tool for pleural pathologies. Thoracoscopic procedures using modified small incisions with scopes are referred to as video-assisted thoracic surgery or VATS. This term is probably more appropriate now than thoracoscopy, which simply suggests the use of a scope to look inside the thoracic cavity and mostly as a diagnostic tool. Advances in endoscopic stapling, better scopes, instruments and video processing allowed widespread use of VATS and expanded the scope of the practice from a diagnostic procedure to become the standard of practice for the majority of thoracic surgeries today. Currently the majority of thoracic surgeries are being performed using VATS. Analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) by Ceppa et al in 2012 showed increasing prevalence of VATS anatomic lung resection from 8 percent in 2003 to 44 percent in 2010. from all participating centers.[1] Reduced morbidity, improved cosmetics, better exposure and shorter hospital stay are some of the advantages of VATS over open approaches.

In this chapter, indications, techniques, and complications of VATS for both diagnostic and therapeutic procedures are reviewed.

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Last updated: February 22, 2023