Video-Assisted Thoracoscopic Surgery (VATS) pleurodesis is a minimally invasive surgical procedure. It aims to prevent the re-accumulation of air or fluid in the pleural space, the area between the lung and the chest wall. This procedure creates an adhesion, effectively “gluing” the lung’s outer lining to the inner chest wall, much like wallpaper adheres to a wall.
Medical Reasons for VATS Pleurodesis
VATS pleurodesis is performed primarily to address two conditions: recurrent spontaneous pneumothorax and malignant pleural effusion. Recurrent spontaneous pneumothorax involves repeated instances of a collapsed lung, where air leaks into the pleural space, causing the lung to pull away from the chest wall. This air buildup can compress the lung, making breathing difficult and potentially leading to significant discomfort.
Malignant pleural effusion, a different condition, involves the accumulation of fluid in the pleural space, often due to cancer spreading to the pleura. This fluid buildup also restricts the lung’s ability to fully expand, leading to shortness of breath and chest discomfort. By creating an adhesion, VATS pleurodesis aims to prevent both air and fluid from re-accumulating, offering long-term relief for individuals facing these challenges.
The VATS Pleurodesis Procedure
The VATS component stands for Video-Assisted Thoracoscopic Surgery. This minimally invasive approach involves making small incisions, typically one to three, on the chest wall. Through these small openings, a thin tube with a camera (thoracoscope) and specialized surgical instruments are inserted. This allows the surgeon to visualize the pleural space on a monitor without the need for a large incision like in traditional open surgery (thoracotomy).
The pleurodesis part focuses on making the lung’s surface adhere to the chest wall. One common method is mechanical pleurodesis, where the surgeon gently scrapes the outer lining of the lung (visceral pleura) and the inner lining of the chest wall (parietal pleura). This controlled irritation encourages inflammation and scarring, leading to the desired adhesion.
Another technique is chemical pleurodesis, where a substance, commonly sterile talc, is introduced into the pleural space. This creates an inflammatory reaction that promotes fusion of the pleural layers. Both methods aim to obliterate the pleural space, preventing future air or fluid collection.
Hospital Stay and Initial Recovery
Following VATS pleurodesis, patients typically remain in the hospital for several days, usually ranging from three to seven days. A chest tube is routinely inserted during the procedure and remains in place during this initial recovery period. The chest tube drains residual air, fluid, or blood from the pleural space and helps the lung re-expand.
Pain management is an important aspect of the immediate post-operative period. Strategies may include patient-controlled analgesia (PCA) or regional nerve blocks to manage discomfort around the incision sites and chest tube. Early mobility, such as walking short distances, is encouraged soon after surgery to promote lung expansion and prevent complications like pneumonia. Breathing exercises, often guided by a physical therapist, also play a significant role in restoring lung function and aiding recovery.
Life After the Procedure
After discharge from the hospital, patients will have some activity restrictions to ensure proper healing. Generally, heavy lifting, strenuous activities, and vigorous exercise are limited for approximately four to six weeks. The timeline for returning to work and normal activities varies based on the individual’s recovery progress and the nature of their occupation. Patients might notice altered sensation or numbness around the incision sites, which can persist for several months as nerves heal. Regular follow-up appointments with the surgeon are important to monitor recovery and address any ongoing concerns.