Surgical Procedures & Innovations 
Thoracic Minimally Invasive and Video-Assisted Surgery (VATS)
Mark E. Ginsburg, MD and Lyall A. Gorenstein, MD, perform a video-assisted thorascopic procedure (VATS).
Minimally invasive thoracic surgery is also known by the name VATS (short for video-assisted thoracic surgery). Utilizing specially-adapted, videoendoscopic instruments, VATS is used for a variety of diagnostic and therapeutic procedures and involves smaller incisions in the chest wall without the need to spread the ribs to gain access to the lungs or esophagus. In selected patients, most procedures that can be done through a standard incision can also be performed with VATS. Benefits for patients include less postoperative pain, shorter hospital stays, faster recovery from surgery, and a quicker return to full activity.
Some of the more common diseases being treated with VATS by our surgical staff include:
- Emphysema — During Lung Volume Reduction Surgery (LVRS), one incision permits access of the viewing instrument (thoracoscope). Forceps and a surgical stapling instrument are used to remove the affected tissue through two other incisions.
- Interstitial Lung Disease — The diagnosis of interstitial lung disease has become significantly more accurate as a result of VATS. Multiple areas of the lung can be biopsied and scanned to determine the presence of this disorder without the need for a large incision.
- Lung Cancer — VATS is used frequently to assist in the diagnosis, staging, and treatment of lung cancer. In addition to aiding in the diagnosis of pulmonary nodules, VATS can significantly reduce the morbidity associated with the traditional surgical removal of lung nodules.
- Myasthenia Gravis — VATS is used to remove the thymus gland through incisions under the arm. Columbia surgeons also perform transcervical thymectomy, a minimally invasive procedure in which the thymus is removed through a small incision in the lower part of the neck.
- Spontaneous Pneumothorax — VATS affords better visualization of the entire lung surface in patients with spontaneous pneumonthorax (collapsed lungs). Patients who receive this procedure also experience less postoperative pain than traditional surgical methods.
Other Minimally Invasive Thoracic Procedures
VATS for emphysemaVATS.
Performed in the sympathetic nerve through two microscopic incisions, Endoscopic Thoracic Sympathectomy (ETS) seeks to eliminate the constant stimulation of sweat glands in patients with hyperhidrosis, while maintaining other normal nerve function.
The Transaxillary Approach for Thoracic Outlet Syndrome is the preferred method of treatment for patients with severe symptoms related to the compression of the brachial plexus. The transaxillary approach combined with video assistance affords complete visualization of the thoracic outlet through a small incision, enabling decompression with less postoperative pain.
A Personal Story: VATS for Early-Stage Cancer
Leah Richter of Englewood, New Jersey, was diagnosed with lung cancer and underwent a VATS lobectomy at NewYork-Presbyterian Hospital/Columbia. Admitted to the hospital on a Tuesday, she was discharged three days later. Lyall Gorenstein, MD, who performed the surgery says, "People who receive VATS as opposed to open surgery recover more quickly and with less pain and less disruption of their immune systems, an important factor in fighting cancer."
