New high for Thoracic surgery: VATS

For the first time, Max Super Speciality Hospital performed a Video-Assisted Thoracoscopic Surgery (VATS) keyhole surgery of the chest for a collapsed lung on a patient affected from Covid-19 infection.

The surgery was done by Dr Shaiwal Khandelwal, Senior Consultant, Minimally Invasive & Robotic Thoracic Surgery, and his team.

An MBBS and MS in general surgery from Institute of Medical Sciences, Banaras Hindu University, Khandelwal has trained in robotic thoracic surgery and complex cancer surgeries from Memorial Sloan Kettering Cancer Centre, New York, USA.

Excerpts:

What is VATS and how was it used in this case?
VATS is mostly done under general anaesthesia using one-lung ventilation. The breathing at the side of surgery is stopped and continued at the other side while performing surgery. Three 1cm cuts are made over the chest wall without cutting the muscles. The VATS camera is introduced through one port, and inspection and assessment of chest cavity are done by the camera. Vision is provided by high definition monitors. In this case, there was a thick peel over the lung surface which was preventing the expansion of the lung. The peel was removed, enabling its expansion. Sites of air leak were identified, and these leaks were secured using special techniques. After surgery, a drainage tube was inserted through one ports, and the other two ports were closed using self-dissolving sutures. This tube was removed on the third day of surgery and the patient was discharged on the fifth day.

What ailments is VATS used for?
I have been doing VATS and robotic surgery for more than 12 years and most of my work is done by using these minimally invasive techniques. VATS can be utilised to perform almost all the procedures in thoracic surgery. In India, we operate on patients with inflammatory/infective diseases like tuberculosis. Resection of diseased lung and drainage of infected fluids in the chest is commonly performed. Recently we are observing an increase in the diagnosis and surgery for malignant conditions of the chest like lung and oesophageal cancer. VATS is also used for the treatment of chest injuries, myasthenia gravis, various tumours and cysts in the chest, and diaphragmatic paralysis.

Is it risky to perform such surgery on a Covid recovered patient?
Covid patients with lung complications are usually very sick, and surgeries are high risk. The lung tissues are very fragile. These patients would not tolerate open surgery. VATS done with meticulous surgical technique is tolerated well with excellent outcomes.

What’s the recovery rate of patient post-VATS surgery and how price-efficient is it?
There is very fast recovery, and chances of major complications are significantly less with VATS. Patients are discharged after 2 to 4 days after VATS surgery without any chest tubes. Most patients can resume activities after 2 to 3 weeks. Moreover, the price is the same in comparison to open surgery.

What is the future of VATS and hurdles in implementing it in India?
VATS is already gaining popularity, and will soon become the standard of care for chest surgery in all hospitals in India. But the major hurdle in implementing it is awareness amongst treating physicians and phobia of surgery among patients. As more and more centres start doing VATS there would be more centres available for training. Another major hurdle is the cost, particularly for robotics. But as the technique gets popular, more options for robotic platforms would emerge and the prices will come down.