By Brig. (R) Dr. Asif Asghar

Thoracic surgery has undergone a dramatic transformation over the past two decades with the advent of Video-Assisted Thoracic Surgery (VATS). As a thoracic surgeon with over three decades of experience—first within the Pakistan Armed Forces and now in the civilian healthcare system—I have witnessed firsthand the remarkable shift in outcomes, patient satisfaction, and recovery times associated with this technique.

Today, at Advanced International Hospital, Islamabad, we are proud to offer cutting-edge single-port and multi-port VATS procedures, helping patients with a wide range of chest conditions heal faster, with fewer complications and shorter hospital stays.

What Is VATS?

VATS is a minimally invasive surgical technique used to diagnose and treat conditions within the chest (thorax), including the lungs, pleura, mediastinum, esophagus, and diaphragm. Unlike traditional open thoracotomy, which requires a large incision and spreading of the ribs, VATS is performed using one to three small incisions through which a camera and specialized instruments are inserted.

This allows for high-definition visualization of the thoracic cavity and precise surgical manipulation—all while minimizing trauma to the patient’s body.

Why We Choose VATS Over Traditional Thoracotomy

In conventional thoracotomy, patients typically endure significant post-operative pain, prolonged recovery, and higher risk of complications. VATS, on the other hand, offers numerous benefits:

• Smaller incisions (1–3 cm)
• Less post-operative pain and need for narcotics
• Lower risk of infection and bleeding
• Faster return to normal activity
• Shorter hospital stay often 2–4 days on average
• Better cosmetic outcomes
• Comparable or better oncological outcomes in cancer cases

As someone trained in both open and minimally invasive thoracic surgery, I firmly believe that whenever VATS is feasible, it should be the first-line approach—especially in centers like ours equipped with modern surgical and anesthetic support.

Indications for VATS

At Advanced International Hospital, we perform VATS for a wide range of conditions, including:

• Lung biopsy or wedge resection for diagnosis or treatment of lung nodules
• Lobectomy for early-stage lung cancer
• Pleural effusion drainage and decortication in empyema
• Pneumothorax surgery and bullectomy
• Thymectomy in cases of myasthenia gravis
• Esophageal surgery, including mobilization for cancer
• Mediastinal tumor excision
• Diaphragmatic repair and sympathectomy
• Hiatus hernia, diaphragmatic hernia surgeries
• Hydatid cyst surgeries
• Congenital lung deformities in babies
• Chest wall reconstruction for tumors and pectus deformities
• Cervical Rib excision for TOS

Single-Port VATS: A Breakthrough Innovation

While multi-port VATS has been widely adopted globally, we are proud to offer single-port (uniportal) VATS, which involves operating through a single incision of about 3 cm. This technique further reduces tissue damage, pain, and scarring.

Having trained in single-port VATS in Shanghai and introducing it in multiple hospitals across Pakistan, I can attest that this approach is especially beneficial for all patients

In selected patients, we have also successfully performed awake VATS for procedures of shorter duration avoiding general anesthesia altogether—which is particularly helpful for high-risk patients with compromised lung function or cardiac issues. These procedures are performed using local anaesthesia blocks and IV analgesia with sedation.

Case Experience and Outcomes

Over the past five years alone, I have performed 122 of VATS procedures, at CMH, and currently at Advanced International Hospital. The outcomes consistently show:

• Significant reduction in hospital stay compared to thoracotomy
• Lower complication rates (e.g., reduced incidence of pneumonia, wound infection)
• Better long-term pulmonary function in patients undergoing lung resections
• High patient satisfaction, especially among those concerned with scarring or recovery time

One memorable case involved a young man with recurrent spontaneous pneumothorax. Using single-port VATS, we resected the apical bullae and performed pleurodesis. The patient was discharged on the second post-operative day and resumed work within a week—something impossible with open surgery.

Challenges in VATS Adoption in Pakistan

Despite its benefits, the adoption of VATS in Pakistan has been relatively slow due to multiple factors:

• Lack of trained thoracic surgeons in minimally invasive techniques
• Limited availability of endoscopic instruments in secondary and tertiary care hospitals
• Financial constraints in smaller hospitals
• Patient skepticism or lack of awareness about minimally invasive options

However, as awareness increases and training opportunities expand, more surgeons are turning to VATS. I am currently involved in mentoring young surgeons and supporting hospitals across Pakistan to establish VATS programs.

Conclusion

The integration of VATS into routine thoracic surgical practice represents a paradigm shift in how we approach chest diseases in Pakistan. As a surgeon, my foremost priority is to provide the safest, least invasive, and most effective surgical solution to my patients.

At Advanced International Hospital, we are committed to making minimally invasive thoracic surgery more widely available, affordable, and safe for all. I strongly encourage patients facing chest surgical issues to inquire about VATS and consult with trained specialists to explore their options.

With continued innovation, training, and patient education, we can ensure that thoracic surgery in Pakistan evolves to meet global standards and gives our patients the best chance for a swift, comfortable recovery