الفهرس 
ANATOMICAL CONSIDERATIONSOnly 14 pages are availabe for public view
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Abstract
The optimal approach to the thorax depends on a number of variables: (1) bony anatomy, (2) location and extent of the pathology, (3) location of the hilum, and (4) objectives of the procedure. Historically, the posterolateral thoracotomy has been the work horse for the majority of major thoracic procedures. With the movement toward minimally invasive procedures in both cardiac and general thoracic surgery, there has been renewed interest in additional approaches, such as the anterior thoracotomy and muscle-sparing incisions. VATS is a newest of these techniques. These tailored approaches may favorably affect morbidity, operative time, postoperative pulmonary function, muscle strength, and postoperative pain.
Video assisted thoracoscopic surgery (VATS) is a new technique in which standard procedures are performed utilizing a video camera in a much less invasive manner than a standard thoracotomy.
The procedures which are particularly suited to thoracoscopy include apical bleb resection and pleural abrasion, lung biopsy, cancer and node biopsy, sympathectomy and esophagomyotomy.
Other reported uses of VATS in the field of thoracic surgery include management of pleural empyema and chylothorax, mediastinal masses and infections, excision of bronchial cysts, diaphragmatic hernias and injuries, and esophageal surgeries.
In the field of cardiovascular surgery, VATS can be used in closure of patent ductus arteriosus and vascular rings, pericardial diagnostic procedures and formation of pericardial windows, minimally invasive coronary artery bypass surgery, atrial fibrillation surgery, and mitral valve repair.
In the last few years the introduction of perfectly computerized systems helped a new evolution of robotic surgery, especially using VATS. These systems have erased to a large extent the difficulty of using long tools during VATS, and made even the training of VATS easier to doctors.
The main advantage of VATS is the reduction of post operative pain which increases the possibility of hypoxia and myocardial oxygen demand. This is proved by decreased patient controlled analgesia postoperatively.
Less inflammatory response and better post operative pulmonary functions attribute to better prognosis and less hospital stay which are of major concern to a lot of patients and institutes.
VATS should be carried out under general anesthesia with selective single-lung ventilation. This can usually be accomplished using a double-lumen endotracheal tube. A biopsy forceps, scissors or electrocautery, suction, irrigator are the primary tools used in thoracoscopy.
The risk of bleeding during VATS and the difficulty of dealing with significant hemorrhage as well as the adequacy of VATS as a cancer operation remain sources of concern for some thoracic surgeons.
Subcutaneous surgical emphysema, air embolism, re-expansion pulmonary edema, air leaks and spontaneous pneumothorax, wound infection and tumor seeding, as well as empyema and pulmonary fistula are other reported complications of VATS.
Absolute contraindications include a fused lung, markedly unstable patient, shock or cardiac arrest, and an individual unable to tolerate partial or complete unilateral collapse of the lung.
Lesser contraindications include the patient with bleeding tendencies or under anticoagulant therapy, tumor size >5 cm, anticipated sleeve resection, hilar lymphadenopathy, chest wall or mediastinal involvement, neoadjuvant radiation therapy or chemotherapy.