Question

Surgical technique of VATS decortication.

Hint:

VATS decortication is a minimally invasive procedure that offers the benefits of reduced recovery time, less postoperative pain, and faster return to normal activities compared to traditional open surgery.

Answer 1

Video-assisted thoracoscopic surgery (VATS) decortication is a minimally invasive procedure performed to treat conditions like chronic empyema, pleural adhesions, and other diseases that lead to the formation of fibrous tissue (pleural peel) around the lungs. This procedure is aimed at removing the thickened pleural tissue, allowing the lung to expand fully and improve respiratory function.
Step 1: Patient Preparation:
The patient is placed in a lateral decubitus position with the affected side up. General anesthesia is administered, and a double-lumen endotracheal tube is inserted to facilitate one-lung ventilation. The patient is closely monitored throughout the procedure.
Step 2: Insertion of Ports:
VATS decortication involves creating 2 to 3 small incisions on the chest wall, typically between the ribs, to insert the thoracoscope and instruments. The surgeon visualizes the pleural cavity and lung surface using the thoracoscope. The camera provides a high-definition view of the pleura and the extent of the fibrous peel.
Step 3: Decortication:
Using specialized instruments, the surgeon carefully removes the thickened pleural tissue (fibrous peel) from the surface of the lung. This is done using a combination of sharp dissection, cauterization, and mechanical resection. The goal is to achieve complete removal of the pleural peel while avoiding damage to the underlying lung tissue.
Step 4: Postoperative Management:
After decortication, the lung is inspected for adequate expansion, and any air leaks are addressed. A chest tube is placed to drain any fluid or air from the pleural cavity. The patient is closely monitored for complications such as bleeding, infection, or recurrence of pleural thickening.