, Video Assisted throascopic Surgery (VATS)
Minimally invasive thoracic surgical procedures used to diagnose or treat conditions of
the chest (pulmonary, mediastinal, chest wall). The VATS procedure uses a
thoracoscope attached to a video camera to see into the chest. The lens and the
instruments necessary to perform the surgery are inserted between the ribs and into the
chest cavity through one or multiple small incisions.
Indications
Diagnosis and staging of thoracic malignancies
Resection of isolated peripheral pulmonary nodules and bullous lung disease
Lung biopsies and pleurodesis procedures
Complications
Persistent air leaks needing chest tube with water seal
Hemorrhage
Tumor seeding
Benefits
Faster recovery
Less pain
Shorter length of stay
Thoracentesis
Thoracentesis is a procedure in which a needle is inserted into the pleural space
between the lungs and the chest wall. This procedure is done to remove excess fluid,
known as a pleural effusion, from the pleural space to help you breathe easier. It may
be done to determine the cause of your pleural effusion. Some conditions such as heart
failure, lung infections, and tumors can cause pleural effusions.
Indications
Diagnostic – Most patients who have a newly detected pleural effusion
should undergo diagnostic thoracentesis to determine the nature of the effusion
(i.e., transudate, exudate) and to identify potential causes. The exceptions are
when there is only a small amount of pleural fluid with a secure clinical diagnosis
(e.g., viral pleurisy), or when there is clinically obvious heart failure (HF) without
atypical features. Atypical features that should prompt consideration of diagnostic
thoracentesis in a patient with suspected HF include those that suggest an
alternate etiology of the effusion (e.g., bilateral effusions of significantly disparate
sizes (especially if the effusion on the left is larger than on the right), symptoms
of pleurisy, fever, features suggestive of infection or cancer, an echocardiogram
that is inconsistent with HF, a disproportionately high alveolar-arterial oxygen
gradient, and/or the lack of resolution with effective HF therapy.
Therapeutic – Therapeutic thoracentesis is commonly performed for
symptom relief (e.g., dyspnea) or if the fluid has imaging characteristics of a
complicated pleural effusion (e.g., loculations suggesting a parapneumonic
pleural effusion). Therapeutic thoracentesis is also indicated for patients with
pleural conditions that risk pleural thickening and restrictive functional
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