What Is VATS (Video-Assisted Thoracoscopic Surgery)?

For most of a VATS operation, the surgeon isn't looking at your skin at all. They're looking at a screen. A slim camera — a thoracoscope — sits inside the chest through a small opening between the ribs, and everything the team does is watched on that magnified view while long, thin instruments work through one or two neighbouring openings. VATS stands for video-assisted thoracoscopic surgery, and it's best understood as a way of getting in, not a single operation in itself: the same keyhole route can be used to take a biopsy, repair a collapsed lung, treat fluid or infection around the lung, or remove part of the lung itself.

The recording at the top of this page, "Video-Assisted Thoracoscopy," runs to four and a half minutes and shows that camera's-eye way of working in a real case. If you want a second, more diagrammatic look before reading on, this page's other video, "VATS animation", spends a little over three minutes on one specific job done this way — removing air blisters (bullae) from a right lung that has collapsed. Between the two of them you get the honest picture: one approach, many possible tasks.

Step one: you're asleep, and one lung rests

VATS is done under a general anaesthetic, so you'll be fully asleep. You'll be positioned on your side, and a breathing tube does the work for both lungs at first — then, for the operating part, the team can let the lung on the operating side rest and gently collapse while the other lung keeps you breathing. That resting step is what creates the working space: a soft, still lung gives the camera room to move and the surgeon a clear view of the chest wall, the lung surface, and the lining (pleura) around it. Nothing about this part is visible from outside, which is exactly why patients are often surprised at how much was achieved through such small openings.

Step two: the ports go in

Instead of one long incision, the surgeon makes a few small ones — often around a centimetre or so each — between the ribs. One becomes the camera port. The others admit the working instruments: graspers, staplers, and energy devices that can cut and seal tissue. Because the ribs aren't spread apart the way they are in traditional open chest surgery, the chest wall usually comes through VATS with less trauma, and that's the main reason recovery from the keyhole route is often more comfortable in the first days. It isn't the right route for every case, though. A growth in an awkward position, dense scarring from earlier surgery or infection, or a problem found during the operation can all be reasons for the team to recommend — or switch to — the open approach, and that switch is a safety decision, not a failure.

Step three: the job itself happens on screen

What happens next depends entirely on why you're there, and this is where VATS earns its keep as a platform rather than a procedure. The camera lets the surgeon inspect the lung and pleura directly, take samples of tissue or fluid for the laboratory, remove a small wedge of lung, or deal with the leak behind a collapsed lung. Bigger operations travel through the same ports too: removing a whole lobe, the operation our guide to lobectomy walks through, is commonly done as VATS surgery, and our cancer hub gathers the related guides if a biopsy or lobe removal is part of a cancer workup. Samples taken during VATS go for laboratory analysis, and it's often that result — rather than anything seen on the day — that decides what, if anything, happens next.

Step four: a drain, then waking up

Before the ports close, a soft tube — a chest drain — is usually left between the ribs. It gives air and fluid somewhere to go while the lung re-expands and seals, and it stays in for some days afterwards, until the drainage settles; our guide to the chest tube explains what living with one is like. You'll wake in a recovery area, be encouraged to sit up and walk early, and use the pain relief you're offered — breathing deeply matters more than stoicism here. Most people go home once the drain is out and they're moving comfortably, and tiredness that lifts week by week is the normal pattern after that. Your own unit's instructions come first, as always: a fever, a wound that's getting redder or leaking, worsening breathlessness, or coughing blood all deserve a prompt call to the team that operated on you.

References & further reading

• MedlinePlus Encyclopedia — Lung surgery: https://medlineplus.gov/ency/article/002956.htm
• MedlinePlus — Lung Cancer: https://medlineplus.gov/lungcancer.html
• NHS — Treatment for lung cancer: https://www.nhs.uk/conditions/lung-cancer/treatment/

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Frequently Asked Questions

Is VATS the same as keyhole or minimally invasive chest surgery?

Yes — those are the everyday names for the same approach. The surgeon works through small openings with a camera instead of one large incision, watching the inside of the chest on a screen. The job done inside can still be a major operation; "keyhole" describes how the team gets in, not how big the surgery is.

What can VATS be used for?

Commonly: biopsies of the lung or its lining, treating a collapsed lung, draining or treating fluid and infection around the lung, removing a small wedge of lung, and removing a lobe. Your surgeon will explain which of these applies to you and why the keyhole route fits — or doesn't fit — your case.

Will I definitely avoid open surgery if I'm booked for VATS?

Not with absolute certainty. Most VATS operations finish as planned, but if the view is poor, the anatomy is awkward, or something unexpected is found, the surgeon may convert to an open incision to finish safely. Teams usually mention this possibility beforehand so it isn't a surprise.

How long is recovery after VATS?

It varies with the job that was done — a biopsy and a lobectomy are very different undertakings. The chest drain is often the pacing item in hospital, and most people build walking and stamina back over the following weeks. Your unit will give you its own expected range and its own list of symptoms to report.

This article is for general education only and is not medical advice. It does not replace consultation with a qualified clinician. Worsening breathlessness, chest pain, or coughing up blood needs prompt, urgent medical assessment.

Dr. Mohamed Ibrahim, MD, PhD

Physician-scientist · Founder, MedicalVideos.com

Dr. Ibrahim founded MedicalVideos.com in 2007 to make medical and surgical education freely accessible to students, clinicians, and patients.

Last reviewed: 11/07/26