The significance of VATS biopsy in determining histopathological findings

Abstract

Video-assisted thoracoscopic surgery /VATS/ is minimally invasive thoracic surgery which provides adequate visualization despite limited access to the thorax. VATS is used for both diagnostic and therapeutic pleural, lung, mediastinal and esophageal surgery. VATS biopsy is often used to determine the clinical status and histopathological findings in both malignant and benign diseases, such as lung cancer, esophageal cancer, lymphomas, mesothelioma, tuberculosis, sarcoidosis, pulmonary fibrosis, etc. A surgical biopsy is mandatory when both the clinical and radiological findings are inconsistent for proper diagnosis. Using thoracoscopes and fiber optic cables, this technique offers surgeons the advantage of clear visualisation of the lungs, mediastinum and pleura, along with retrieving tissue for histopathological examination. Under general anaesthesia with selective lung ventilation, the thoracoscope is introduced through a small incision into the pleural cavity while the lung on the operative side is deflated to allow clear visualisation. Investigation of the lung, pleura and mediastinum is carried out. Tissue and fluid are removed under visual control for histo- and cytopathological examination. At the end of the procedure chest tube drainage is inserted into the pleural cavity and the lung reexpanded. Although this technique holds several risks including infection, persistent air leak, bleeding, intercostal nerve damage, respiratory insufficiency and pneumonia, and also tumor implantation, it offers patients fewer risks in comparison to open chest thoracotomy biopsy, with a faster operative time and recovery time, less postoperative complications and pain.