VATS stands for video-assisted thoracoscopic surgery, a minimally invasive technique used to diagnose and treat problems inside the chest. Instead of opening the chest with a large incision and spreading the ribs apart, surgeons make a few small cuts (typically 2 to 5 centimeters each) and use a tiny camera to guide the operation on a video screen. VATS is now one of the most common ways surgeons operate on the lungs, the lining around the lungs, and other structures in the chest cavity.
How the Procedure Works
VATS is performed under general anesthesia. A special breathing tube allows the surgeon to temporarily deflate one lung, creating space to see and work inside the chest. You’re positioned on your side with the affected lung facing up, and the operating table may be angled to improve the surgeon’s view.
The surgeon typically makes 3 to 4 small incisions arranged in a triangle pattern on the side of your chest. Through one of these, a thin camera called a thoracoscope is inserted. It sends a live, magnified image of the chest cavity to a monitor. Surgical instruments go through the remaining incisions, letting the surgeon cut, staple, or remove tissue while watching the screen. In some cases, the entire procedure can be done through a single incision of 3 to 5 centimeters. Some specialized centers have pushed that down to as little as 2 centimeters using ultra-thin cameras.
Once the operation is finished, one or two drainage tubes are placed through the incisions to remove air and fluid from around the lung. The incisions are then closed.
Why It’s Done
VATS can be used for a wide range of chest procedures, both diagnostic and therapeutic. Surgeons use it to take biopsies of lung tissue or lymph nodes when imaging alone can’t provide a clear answer. It’s also a standard approach for removing part of a lung (a wedge resection, segmentectomy, or full lobe) to treat early-stage lung cancer or lung metastases from cancers that originated elsewhere in the body. Other uses include draining fluid collections around the lungs, treating collapsed lungs, and addressing infections or tumors in the space between the lungs.
VATS vs. Open Chest Surgery
The traditional alternative is an open thoracotomy, where the surgeon makes a large incision (often 15 to 20 centimeters) between the ribs and spreads them apart for direct access. VATS avoids that rib spreading entirely, which is the main reason it causes significantly less pain afterward.
The clinical differences are well documented. Patients who have VATS spend roughly 2 fewer days in the hospital compared to those who have open surgery. They tolerate chemotherapy better afterward when it’s needed, and they recover faster overall. For early-stage lung cancer, a study in the Journal of Cardiothoracic Surgery found that the 5-year overall survival rate was 94.1% for VATS patients compared to 81.8% for those who had open surgery, with no meaningful difference in cancer recurrence. The less invasive approach appears to produce outcomes at least as good as, and possibly better than, the traditional method.
That said, not every procedure can stay minimally invasive. About 14% of VATS operations end up converting to open surgery, most often because of unexpected bleeding or because the disease is more advanced than scans suggested. Obesity, male sex, and later-stage cancer are independent risk factors for conversion.
What Recovery Looks Like
The chest drainage tube is usually the biggest factor in your hospital timeline. It typically comes out 1 to 3 days after surgery, and most patients go home within hours of removal or the following morning. Pain is managed with oral medication in the days after discharge, and most people gradually taper off within the first week or two.
The most common complication is a prolonged air leak, where air continues to escape from the lung surface into the chest cavity after surgery. This happens in roughly 3% to 15% of cases depending on how much lung tissue was removed, with larger resections carrying higher risk. A prolonged air leak usually means the drainage tube has to stay in longer, which extends the hospital stay. It can also increase the chance of pneumonia or the need for readmission. Most air leaks seal on their own with time and don’t require a second operation.
Before the Surgery
If you’re having VATS for a lung resection, your surgical team will test how well your lungs function beforehand. The key measurement is how much air you can forcefully exhale in one second, expressed as a percentage of the expected value for your age and size. When that number falls below 80%, the risk of postoperative breathing complications rises, and additional testing is usually recommended. Some patients with values as low as 45% to 60% can still safely undergo the procedure, but the evaluation becomes more involved, often including exercise testing to see how the heart and lungs perform under stress. Heart function is assessed as well, since the way your heart rate responds to exercise can predict cardiovascular complications after surgery.
These preoperative evaluations help the surgical team weigh the benefits of the procedure against the risks for your specific lung and heart capacity, and they guide decisions about how much tissue can safely be removed.