“Video-assisted thoracoscopic surgery (VATS) is a well established procedure. The key hole surgery has been used since the early 90s. Over the years there have been many developments and innovations in this field. In the USA it is now routinely used in lung cancer patients

Dr. Klijian from The Cardiothoracic Surgery Department, Sharp & Scripps Hospitals, San Diego, United States writes that Patients with poor pulmonary function are often precluded from surgical therapy. Now Awake video-assisted thoracic surgery (AVATS) done under local anesthesia and sedation allows for surgical resection of lung cancer previously deemed inoperable. Wedge resection, segmentectomy and even lobectomy are feasible and have been performed with outcomes comparable or better than those done under general anesthesia. Over 500 AVATS cases have been performed without significant morbidity or mortality. Lung resections for cancers done via AVATS have a length of stay for lobectomy of 1.6 days, even in patients with FEV1 under 0.6. These patients have multiple comorbidities including diabetes, COPD, atrial fibrillation, hypertension and hepatic and/or renal dysfunction. Of the patients undergoing resection, 203 of the 246 patients had FEV1 less than 0.8. Postoperative care of these patients has also been streamlined to minimize use of central lines, arterial, urinal and epidural catheters to minimize nosocomial infections. AVATS is a safe option in select lung cancer patients, who previously would be classified inoperable, resulting in lower length of stay, better patient satisfaction and presumably lower costs.

The availability of the AVATS procedure is expected to increase, as Dr. Klijian has presented the technique and trained a number of other surgeons.