VATS

VATS, an acronym that sounds strange to patients, stands for video-assisted thoracic surgery. Similar to laparoscopic surgery of the abdomen, the surgeon makes small incisions in the side of the chest to access the lungs. A 60 year old long-time smoker presents with a lung mass requiring a biopsy. The surgeon's plan is to use a camera and tools to go in through small VATS incisions and take a piece of the mass to find out if it is cancer or something else. This sounds easy enough, but the anesthesia is not straightforward. Can we stop the patient's breathing to allow the surgeons to work on a stationary field? The answer is clever: we isolate the patient's two lungs. The breathing tube we place is specially designed with two lumens and two balloons. Using a fiberoptic bronchoscope, we position it in order allow selective inflation and deflation of the two lungs. This type of intubation has its risks as well; we have to be vigilant for signs of tube movement as that can cause lots of problems. We also have to be able to oxygenate and ventilate the patient with just one lung while the surgeon works on the other one. All of these challenges makes thoracic anesthesia an interesting and satisfying field.