Anaesthesia for Video- Assisted Thoracoscopic Surgery

Abstract

The • development of video technology over the last few years has permitted minimally invasive thoracic surgery to replace open thoracotomy for a large number of surgical indications. Video assisted thoracic surgery allows complete visualization of the pleural space with evaluation of both the parietal and visceral pleural surfaces. VATS has therefore become the surgical procedure of choice in the diagnosis and treatment of most pleural and some pulmonary, pericardia! and mediastinal diseases. VATS is now widely used for resection of small peripheral pulmonary nodules and biopsy of interstitial lung disease. VATS is also useful for treating patients with spontaneous pneumothorax or giant bullae, and recently was used in performing volume reduction for patients with diffuse emphysema. Basic operative set up and procedure, suggested approaches to various thoracic surgical problems as well as intercostal approach strategy was illustrated, showing the importance of instrument positioning and different windows for access to variable intrathoracic lesions as wedge resection of peripheral pulmonary nodules and closed lung biopsy, pericardiectomy approach, approach to aorto-pulmonary window, approach to apical bullous disease, approach to anterior mediastinal masses, as well as approach to posterior mediastinal masses and dorsal sympathectomy. During VATS there are some physiological changes occuring during lateral decubitus position. During spontaneous breathing in an unanaesthetized individual, the dependent lung is better ventilated than the upper non-dependent one owing to the action of diaphragm has increased ventilation. This increased ventilation is matched by increased perfusion leading to minimal shunt.