Minimally-Invasive Thoracic Surgery (VATS)

Definition/Etiology:

• Definition
  • Video-assisted thoracic surgery (VATS) is a type of minimally invasive procedure
    that can remove parts of the diseased lung and lymph nodes.
  • Minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications
• Etiology -Several
  • Lungs
    • Cancer, Fluid, Air, etc
  • Esophagus
    • Tumors
  • Diaphragm
    • Hernia Repair

Pathophysiology:

• General Anesthesia 2-3 Hours
• Lung Surgery = Paralyze 1 lung “AKA” 1 lung ventilation.
• In video-assisted thoracoscopic surgery (VATS), a small tube called a thoracoscope is inserted through a small cut (incision) between the ribs. At the end of the tube is a small camera.
• This lets the surgeon see the entire chest cavity without having to open up the chest or spread the ribs.
• ANALOGY
  • The best analogy would be if you’re working on your house, I can gash open your roof and drop a crane in and do the floor repair through your roof, causing collateral damage, or I can come through small side windows into your house to work on your flooring.
• Any surgery = possible complications

Noticing: Assessment & Recognizing Cues:

• COMPLICATION WATCH
• Subjective Cues
  • Incisional Pain
    • Patient’s chief complaint varies with the type of surgery but is often incisional pain.
• Objective Cues
  • Incision
    • Complications
    • Especially bleeding & Infection
  • Heart/Lungs
    • ↑HR + ↓02 Sat
    • Tachypnea + Fever = Pneumonia
      • Shallow Respirations from Sedations + pain
    • Watch for Resp Distress
      • Nicking a lung

Interpreting: Analyzing & Planning:

• Labs
  • ABG
    • Pre/Post surgery to compare
    • Routine – R/O Infection & Bleeding
• Diagnostics
  • Heart Monitor
    • Stable Hemodynamics (monitor for bleeding)
  • CXR –
    • Pneumothorax & Tracheal Deviation
      • from “nicking” lung tissue
    • Atelectasis
      • Shallow breathing from pain or anestesia
    • Pneumonia

Responding: Patient Interventions & Taking Action:

• ABCs + Underlying Cause
  • Wean Vent → Nasal Cannula
    • GCS 8
    • Spontaneous breathing
    • Pa02/Fio2 > 200
    • Hemodynamically stable
• Pharmacological
  • Pain Control
  • What else is going on?
    • Infection = ABX
    • Hemothorax = Blood Products
• Interventions Non-Pharmacological
  • Chest tube management
  • Incentive Spirometry
  • Cough & deep breath
  • Turning/Passive ROM → Ambulate
• Adjunct Medical Therapy
  • Surgeon
  • Pulmonologist
  • PT/OT – EARLY MOBILITY

Reflecting: Evaluating Patient Outcomes:

• Oxygenation & Gas Exchange
  • Prevent or minimize postoperative pulmonary complications
  • 02 sat, ABGs, P/F Ratio, lung sounds
• Symptom
  • Pain – Find the sweet spot, don’t overmedicate as patient will be intubated again
• Patient Education
  • Splint Coughing
    • Reduces pain
    • Protects sutures/incisions
  • Skin around incision may be numb up to 6 months

Linchpins (Key Points):

• Notice
  • Minimally Invasive but POST-OP
• Interpret
  • Labs & Diagnostics
• CHEST TUBE AND INCISION
  • If you are shaky on chest tubes this would be a good time to revisit that information. It will be covered in the Pleural Space Compilation video.
• Reflect
  • ABCs
  • Complication Free?
  • Education