Video-assisted thoracic surgery utility in veterans: a narrative review

Abstract

Background and Objective: Over the last several decades, the use of minimally invasive techniques in thoracic surgery has rapidly expanded. This trend has also been observed at veterans affairs (VA) medical centers, though their uptake of video-assisted thoracic surgery (VATS) is thought to have lagged behind civilian hospitals. This review aims to outline the available evidence related to the use of these techniques within the VA system. Methods: We performed a review of studies describing thoracoscopic surgery at the VA in PubMed. We identified studies that were published in the English language. There were no publication date restrictions. We excluded review articles or systematic reviews with no accompanying meta-analysis. Studies were evaluated for inclusion based on title and abstract. The authors then performed a more detailed review of the full manuscript for inclusion. A total of 10 studies met inclusion criteria and were included in our review. Key Content and Findings: Most investigations on the implementation and efficacy of VATS within the VA healthcare system have focused on the treatment of early-stage lung cancers, which have demonstrated that VATS use decreases pulmonary complications in addition to minimizing direct tissue trauma and pain. Thus, VATS has become the predominant technique used in VA pulmonary resections over the last decade. VATS use at the VA has also increased for other procedures, including thymectomy and esophagectomy, with promising improvements in the rate of patient complications. As uniportal and robotic-assisted techniques have begun to gain traction nationally, VA centers have also begun to incorporate them into routine thoracic surgery practice. However, data comparing outcomes to VATS techniques in VA populations remains lacking. Conclusions: Thoracoscopic procedures decrease perioperative pain and disability, improve patient outcomes, and are feasible to perform within the VA system. It is critically important that the VA continue to incorporate minimally invasive techniques in an effort to optimize care for the veteran population and its unique set of needs.