Complications of Video-assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) is gaining in popularity greatly in the human field and has begun to become commonplace in a relatively small number of veterinary centers. As with any new surgical intervention or approach the “early adopter” phase of development, which veterinary medicine arguably still finds itself in, can be plagued by challenges and complications that may in many cases be unforeseen. It is therefore imperative to tread carefully with regard to case selection and ensure that high-quality equipment is available and further training is sought in order to ensure success. These strategies will help to minimize perioperative morbidity and the need to convert to an open approach.

In order to perform VATS approaches in dogs and cats it is necessary to create a working space. While some techniques can be performed under a pneumothorax alone, many more advanced procedures require the use of one-lung ventilation or thoracic insufflation in order to be completed successfully. This requires an indepth knowledge and familiarity with special anesthetic techniques and monitoring. An important potential source of perioperative morbidity in these cases results from inappropriate anesthetic management or patient comorbidities and this should be considered in detail prior to surgery. A detailed discussion of anesthesia for VATS approaches is beyond the scope of this lecture and some aspects of the challenges of anesthetic management for VATS have been discussed elsewhere in this session.  [...]