Video-Assisted Thoracoscopic Surgery (VATS)

Scoliosis doctors use VATS to treat very specific kinds of scoliosis in children. For example, your doctor may recommend VATS if your child meets the following criteria:

• A doctor has diagnosed your child with severe idiopathic scoliosis (>80 degrees of thoracic curvature)
• The curvature in question is rigid instead of flexible in nature
• Your child has yet to reach skeletal maturity, maximizing the effectiveness of this intervention
• Your child would otherwise require a thoracotomy (a much more invasive form of correction) to reverse their curvature

However, certain types of patients are less likely than others to tolerate VATS. For instance, your doctor will not recommend VATS if your child has a condition that prevents him or her from undergoing single-lung ventilation (a key step in most of these procedures). Likewise, your child might not qualify for VATS if he or she has significant lung scarring from a previous procedure; or if his or her scoliotic curvature juts out into the chest wall.

Outside of the scoliosis world, surgeons use VATS to treat and diagnose a wide range of conditions that affect the thorax, heart, and lungs. One of the most common reasons that doctors perform VATS, for instance, involves removing a portion of lung affected by cancer. Of course, the applications of this procedure don’t just end there. Your doctor may use VATS to biopsy the lung, lymph nodes, surrounding respiratory or cardiovascular tissues, or the esophagus.

Likewise, heart procedures, like pacemaker lead placement or mitral valve repair, may also use VATS. In addition, your surgeon may use VATS to:

• Drain fluid from a lung (infection) or cardiovascular system (infection/inflammation)
• Drain an abscess
• Prevent pleural effusions
• Treat gastroesophageal disease associated with surgery
• Remove restrictive fibrous tissue surrounding the respiratory system
• Repair congenital chest wall conditions
• Treat diaphragm paralysis

The answer to this question depends on the application of VATS. For brevity, we will examine one of the most common minimally invasive procedures that uses VATS: a thoracoscopy.

A thoracoscopy is essentially an endoscopy that allows for access to the chest/thoracic spine region. Using thoracoscopic guidance, surgeons can achieve access to the thoracic spine through a series of lateral entry points on the chest wall. Sometimes, the surgeon must also deflate a single lung (known as single-lung ventilation) to achieve optimal access to the spine.

In the past, surgical treatment for thoracic scoliosis inevitably meant an open procedure for the patient. These leave large scars and take much longer to heal when compared to minimally invasive procedures. Instead of making a large incision, the surgeon uses a series of small incisions to access the affected area. Then, the surgeon uses these small access points as entryways for their endoscopic instruments.

In most cases, scoliotic curve reduction usually results in the removal of a number of intervertebral discs. Additionally, many of these scenarios also involved fusion as well as spinal instrumentation. More specifically, surgeons use the latter two to correct the abnormality in the spine, as well as to provide spinal stability.

In short, several incisions are made on the side of the body to allow endoscopic access to the affected area. The surgeon then uses these instruments to navigate through the procedure. Typically, scoliotic curve correction means that a number of intervertebral discs and end plates will be removed. Once the surgeon performs the necessary steps for the patient’s specific needs, the instruments are removed and the incisions are closed.