VATS Lung Surgery
London

VATS is surgery inside the chest performed through small incisions, usually one to three, each a few centimetres long, using a video camera and long instruments instead of a large incision between the ribs. The ribs are not spread, which is the main reason recovery is faster and pain is less than after open surgery. The operation is performed under general anaesthetic with the lung on the operated side deflated to make room to work.

At the end of the operation a chest drain is placed through one of the incisions, and local anaesthetic blocks are placed by the surgeon under direct vision. Most patients are walking the same day or the next morning, and the drain is removed when the lung has sealed, usually within one to three days.

VATS is used for operations on the pleura and the lung surface and for operations that do not need articulated instruments: pleural biopsy and pleurodesis, pneumothorax surgery, bullectomy, ETS, washout of pleural infection, and lung biopsy or wedge resection. Lobectomy can be performed by VATS where it is the better approach for an individual patient.

• VATS pleural biopsy and talc pleurodesis — for recurrent or malignant pleural effusion
• VATS bullectomy and pleurectomy — for pneumothorax that has recurred or has not resolved
• Bullectomy for giant bulla — where a large air space is compressing working lung
• Bilateral endoscopic thoracic sympathectomy (ETS) — for hyperhidrosis, facial flushing and blushing
• VATS washout and decortication — for pleural infection (empyema)
• Wedge resection and lung biopsy — where tissue is needed and cannot be obtained by bronchoscopy
• VATS lobectomy — where it is the better approach for an individual patient

Both are keyhole surgery. The difference is the instrument: in VATS the surgeon holds rigid instruments directly, in robotic surgery the surgeon controls articulated, wristed instruments from a console with a magnified three-dimensional view. For anatomic lung cancer operations, lobectomy and segmentectomy, where the lung’s blood vessels and lymph nodes are dissected individually, the robot is Dr Okiror’s standard: at Guy’s and St Thomas’ 71.3% of anatomic resections are performed robotically, against 24% nationally. For pleural and pneumothorax surgery, ETS and biopsy, VATS does the job with fewer incisions and no loss of precision.

The approach is chosen to suit the patient and the operation. Where a patient has had previous chest surgery, where the pleura is likely to be stuck, or where the task is a quick pleural procedure in a patient who is unwell, VATS may be the safer and simpler route. Where the task is a cancer operation with lymph node dissection, the robot is. Both approaches are available at London Bridge Hospital and The Lister. The robotic programme is described on the robotic lung surgery page.

Most patients go home one to four days after a VATS operation and are back to normal activity within two to four weeks. ETS patients usually go home the next day; pleural and pneumothorax surgery usually means two to four nights while the drain is in. The enhanced-recovery pathway, from pre-assessment to the specialist nurse call at home, is set out on the recovery page.

Risks, stated plainly. An air leak from the lung surface that keeps the drain in for longer; bleeding; infection; and pain at the incision sites. Occasionally a keyhole operation has to be converted to an open one to complete it safely. Each risk is discussed in full at the consultation with the figures that apply to your operation.

Guide prices at London Bridge Hospital, each covering the hospital, surgeon and anaesthetist fees for an uncomplicated stay, with hospital charges the largest part: VATS pleural biopsy with talc pleurodesis £10,000–£14,000; bilateral ETS £11,000–£14,000; VATS bullectomy with pleurectomy £12,000–£16,000; robotic or VATS lobectomy or segmentectomy £25,000–£30,000. The hospital issues a written fixed quote after consultation and before treatment. All guide prices and how fees work →

Dr Okiror is recognised by AXA Health, Bupa, Aviva, Vitality, WPA and Cigna, and by most other UK and international insurers. If you have private medical insurance, Dr Okiror and the hospital bill your insurer directly, and insurers usually settle the hospital, surgeon and anaesthetist fees in full, less any excess written into your policy. Please confirm with your insurer that your policy covers treatment at London Bridge Hospital or The Lister before your first appointment. Self-paying patients are equally welcome.

How quickly treatment happens. Surgery is usually within a week of completing investigations. Patients who already have their tests can be booked for surgery within days of their consultation. Urgent cases can be booked for surgery within 48 hours. Patients who are unwell and attend the Urgent Care Centre at London Bridge Hospital are admitted directly to the ward, and surgery is usually within 48 hours. Transfers from NHS hospitals are arranged by the HCA Medical Concierge team.