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Video Assisted Thoracoscopy (VATS)

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Video Assisted Thoracoscopy (VATS) Video Assisted Thoracoscopy (VATS) Information for patients Thoracic Surgery PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST This leaflet has been written to provide information about your procedure. We hope it answers some of your questions or concerns. It is not intended to replace talking with medical or nursing staff. What is a Video Assisted Thoracoscopy (VATS)? This is a procedure which allows the surgeon to examine your lungs and the area around your lungs (pleural cavity). The procedure is performed under general anaesthetic. Once you are asleep, your surgeon will make one small cut in the side of your chest (uniportal or one incision). Alternatively, your surgeon may need to make 2 or 3 small cuts. A thin tube with a light and camera on the end (thorascope) is then inserted through the cut(s) to allow your surgeon to see the lung and space around it. X page 2 of 16 At the end of the procedure whilst you are still asleep you will have a chest drain inserted to allow fluid and/or air to drain. This also aids expansion of your lung. X X Why do I need a VATS? Your surgeon will discuss with you before your operation what they intend to do and why they are doing it. With a VATS procedure, the surgeon can: • Remove small amounts of lung tissue or the lining of the lung (pleura) for examination in a laboratory (biopsy) • Drain air or fluid from the area around the lung (pneumothorax or pleural effusion) • Remove part of the lung (lobectomy, wedge resection) or the whole lung itself (pneumonectomy) • Treat a collapsed lung (pleurectomy and/or decortication) • Remove pus (debridement) page 3 of 16 Are there any side effects or risks with VATS? Major complications following VATS are rare. Common ones may include: • bleeding at the incision / drain site • infection at the incision / drain site • pain at the incision / chest drain site • air leak from the lung Before you sign your consent form, the surgeon will discuss with you in more detail the risks involved with your procedure. It is important to be aware that the surgeon may not be able to complete the intended procedure with VATS and that an open procedure (thoracotomy) may be needed. What are the benefits of VATS? The procedure provides your doctor with important information. This may help to diagnose or rule out certain conditions, treat certain conditions, and/or determine best treatment options. If you are suffering with shortness of breath due to excess build up of fluid around your lung, then draining may help your breathing. The potential advantages of VATS over open surgery are a better appearance of scars, quicker recovery and less pain. Are there any alternatives? This depends on your condition and symptoms. Your doctor will be happy to discuss any alternatives with you. Other procedures that obtain samples of lung tissue are: • Needle biopsy - a small needle is inserted through the skin under local anaesthetic. page 4 of 16 • Bronchoscopy - a tube with a camera and light source is passed down your windpipe into your lungs to obtain a sample of lung tissue. To drain fluid from the lung cavity: • Pleural aspiration - a needle is inserted through your chest under local anaesthetic to draw off fluid from the area around the lung (pleural space). How do I prepare for this procedure? Your general health and fitness will need to be assessed before your operation can take place. You will need some or all of the following: • Chest X-Ray (CXR) - this shows basic information about your lungs and heart. • ECG (heart tracing) - this records the electrical activity of your heart; its rate and rhythm. • Breathing test (respiratory function tests or RFTs) to show how well your lungs are working. • Blood tests tell us how your kidneys and liver are functioning. • MRSA screen (Methicillin Resistant Staphylococcus Aureus). MRSA is a common germ (bacteria) that is carried on the skin and in the noses of many people without causing any harm or infection. However if you have a surgical wound it may cause infection. All patients are screened before admission to see if they carry MRSA. We provide cream and body wash to treat this if you do carry this germ. Surgery is not usually cancelled. • Quantiferon blood tests - these are required when the pathologists are due to examine your lung tissue (biopsy) whilst you are still asleep (this is called a frozen section). Quantiferon tests show whether you have previously been exposed to Tuberculosis (TB) and it allows the pathologists to decide which precautions to take and which tests to perform on your biopsy. A page 5 of 16 positive Quantiferon test does not mean that you are affected by TB and it does not usually interfere with your surgery. However if the results of the Quantiferon show that you have been exposed to TB and further assessments are required, your Consultant will organise them and get in touch with you. This might include a consultation with a TB specialist prior to your admission. You may have some of these tests done on the same day you see your Consultant when you are referred for surgery or you will be sent an appointment to attend a pre-operative assessment clinic (POAC). Pre-Operative Assessment Clinic We ask that you attend this clinic to ensure all the information needed is available before your operation. The clinic appointment lasts 3 to 4 hours. This clinic takes place in the Chesterman Out-Patients Department at the Northern General Hospital in Sheffield. Please bring all your medications with you so that we can review them before your upcoming procedure (or bring an up to date printed list from your GP). You will be seen by a nurse, a doctor / nurse practitioner and a member of the anaesthetic team. They will discuss how they will look after you. You will be advised when you need to stop eating and drinking before surgery. This is also an opportunity to ask questions and discuss any concerns regarding your condition or care when you go home from hospital. You may wish to bring a family member or friend with you. Before you come into hospital, please give some thought as to how you will cope after discharge. During the first few weeks at home you may need practical as well as emotional support. page 6 of 16 Smoking We ask that you stop smoking before your operation, as continuing to smoke will increase your risks. Research shows that people who stop smoking have a shorter recovery period following an operation. We will offer you help with stopping smoking through an NHS support programme. We strongly advise you to take advantage of this offer of help. Please ask for a copy of the 'Stop before your op!' advice leaflet which is available in the pre-operative assessment clinic. Before your operation Pre-op energy drinks At the Pre-operative Assessment Clinic we will give you a pack of four 'Pre-op' supplement drinks. • The evening before surgery please drink two of these drinks • On the morning of surgery please drink the final two drinks - no later than 6am. Patients with diabetes should not receive these drinks. Bathing Please have a shower or bath as it helps reduce the amount of naturally occurring bacteria on your skin. However please do not use highly scented soaps and do not use deodorant, talcum powder, perfume or body spray afterwards. Also please brush your teeth or clean your dentures as this helps to reduce the risk of infection. We will need to remove excessive hair from the area where your incision (cut) will be. Please do not do this at home we have special surgical clippers to do this. page 7 of 16 Medication We ask that you bring all your medications with you, in their original packs, for use during your stay. Admission to hospital Where do I go? You will be admitted to hospital either on the morning of surgery or the afternoon before. We will discuss this with you at the pre-operative assessment clinic. You will be admitted to the Cardio-thoracic Theatre Admission Unit (CTAU) or Chesterman 3 ward at the Northern General Hospital, Sheffield. What should I expect? You will be seen by the surgeon who will discuss your surgery with you and obtain your written consent. He/she will also mark the operation site with a skin marker pen - so you know that the correct area of lung is being operated on. As with any procedure we must seek your consent beforehand. Staff will explain the risks, benefits and alternatives before they ask for your consent. If you are unsure about anything, please do not hesitate to ask for more information. You will be taken to theatre by a nurse and a support worker. On arrival at theatre another nurse will take over your care. How long does it take? The procedure takes approximately one hour. However, you will be away from the ward for 3 to 4 hours as time spent in the anaesthetic room and recovery area can vary from person to person. page 8 of 16 After surgery When your operation has finished, you will be taken to the theatre recovery area. You will stay there until you are awake, comfortable and ready to return to the ward. You will be wearing an oxygen mask to help you recover from the anaesthetic. On return to the ward the nurse will check your pulse and blood pressure regularly. You will have a drip to give fluids until you are able to drink.
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