VATS pleurodesis is a surgery that treats a buildup of air or extra fluid around your lungs.
What is Video-Assisted Thoracoscopic Surgery?
Video-assisted thoracoscopic surgery (VATS) is a minimally invasive type of chest surgery. The surgeon uses small cuts to insert a tiny video camera and surgical instruments instead of making a large incision for open surgery.
What is Pleurodesis?
Pleurodesis is a procedure designed to get rid of the space between your lung and your chest wall to keep air or fluid from collecting there. The surgeon irritates the outside lining of your lung and the lining of your chest wall, which makes them stick together. The lung bonds to the chest wall, and the space between is sealed off.
There are two methods for causing this irritation:
Chemical pleurodesis. The surgeon puts a chemical, usually talc, into the pleural space (the space between your lungs and your chest wall.)
Mechanical pleurodesis. The surgeon abrades (brushes) the outer lining of the lung and the inner lining of the chest wall with dry gauze.
Conditions Treated with VATS Pleurodesis
Doctors use pleurodesis to treat:
Pleural effusion. A pleural effusion is a buildup of excess fluid in the pleural space. It can cause chest pain, a dry cough, and difficulty breathing. Pleurodesis can treat pleural effusions that are difficult to drain or keep coming back over and over. Pleural effusions caused by cancer are the most common reason for VATS pleurodesis.
Pneumothorax. A pneumothorax happens when air gets into the pleural space, putting pressure on the lung and causing it to collapse. Symptoms include chest pain, coughing, a fast heart rate, and shortness of breath. You may need VATS pleurodesis if you have a pneumothorax that doesn’t respond to other treatments or keeps returning again and again.
Risks of VATS Pleurodesis
Complications from VATS pleurodesis can include:
- Air leak
- Bleeding
- Chronic pain
- Infection
How to Get Ready for VATS Pleurodesis
Your doctor will give you specific instructions about how to prepare for surgery. These may include:
Testing. You will probably need to have blood tests, imaging tests like X-rays or a computed tomography (CT) scan, an electrocardiogram (EKG) to check your heart, and pulmonary function tests (PFTs) to check how well your lungs are working.
Stopping certain medications. Tell your doctor about all the medicines you are taking, including over-the-counter drugs. They will let you know which medicines you should keep taking and which you should stop before surgery.
Quitting smoking. Ask your doctor for resources to help you stop smoking before your surgery.
Daily exercise. Check with your doctor about the best kinds of exercise for you.
Breathing exercises. You may need to do special breathing exercises with a device called a spirometer.
Fasting. Typically, you will have to stop eating and drinking by midnight on the day of your surgery.
What Happens During VATS Pleurodesis?
Video-assisted thoracoscopic surgery pleurodesis is done in an operating room. It may take several hours. You will be given general anesthesia, medicine that will put you to sleep so you don’t feel anything during the surgery.
After you are asleep, the medical team will put a breathing tube down your throat so they can send oxygen to your lungs during the surgery. The surgeon will make three small (about 1 inch) cuts in your chest. They will put the tools they need for surgery through these incisions. This includes a special video camera called a thoracoscope that allows them to see into the pleural space.
The surgeon will either apply a chemical irritant evenly throughout the pleural space or perform mechanical pleurodesis. They will probably put in a chest drain, a plastic tube that allows extra fluid to drain from the pleural space. Then, they will remove the surgical tools and close the incisions.
Recovery After VATS Pleurodesis
When you wake up, typically a couple of hours after your surgery, you may feel a bit confused at first. The medical team will be monitoring your heart rate and breathing, so you will be hooked up to some machines. You may have a plastic tube at your nose to give you oxygen, but this is usually temporary.
You will have soreness. If you are in a lot of pain, let your nurse know so they can get you pain medicine. Most people must stay in the hospital for a few days after VATS pleurodesis. While you are in the hospital, you may need to wear compression stockings that help prevent blood clots. You will likely do breathing exercises with a special device that helps you take deep breaths.
Arrange ahead of time for someone to drive you home and for some help around the house while you recover. You will need to avoid driving and heavy lifting for a while, and you will tire easily at first. It may take several weeks for you to fully recover.