Keyhole lung surgery (VATS)
A keyhole way of operating inside the chest using a camera and small cuts, used for many lung operations instead of opening the chest with a large incision.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- VATS is a keyhole approach to chest surgery using small cuts and a camera, not a single operation; many lung procedures can be done this way.
- It usually means less pain and a shorter stay than open surgery, with similar cancer results for suitable early-stage tumours.
- It is still major surgery under general anaesthetic, with real risks, and not everyone is suitable.
- Sometimes the surgeon has to switch to open surgery during the operation for safety; this is not a failure but a sensible decision.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Smaller cuts and usually less pain than open surgery
A large, central or locally invasive tumour that cannot be removed safely by keyhole.
You recover on a ward or high-dependency area with a chest drain, oxygen and pain relief. Physiotherapists help you breathe deeply and start moving.
Early physiotherapy with breathing exercises and supported walking.
You recover on a ward or high-dependency area with a chest drain, oxygen and pain relief. Physiotherapists help...
Drains are removed once any air leak and fluid settle. You build up walking and the team checks your breathing...
Many people go home within a few days. Expect tiredness and wound discomfort, and keep up gentle walking and...
Stamina improves and many return to light activity and desk work, avoiding heavy lifting until advised.
What is keyhole lung surgery (VATS)?
Video-assisted thoracoscopic surgery (VATS) is a keyhole way of operating inside the chest. Instead of a single large cut between the ribs (an open thoracotomy), the surgeon makes one or a few small cuts and uses a camera (thoracoscope) and long instruments, watching the operation on a screen.
VATS is an approach, not an operation in itself. The same procedures done by open surgery can often be done by VATS, including removing a lobe (lobectomy), a wedge or segment, draining or treating the lining of the lung (pleural surgery), taking biopsies, and removing some chest growths.
Compared with open surgery, keyhole usually means less pain, a shorter hospital stay and a quicker return to normal activities, and for early-stage lung cancer studies show similar cancer outcomes. It is still major surgery under general anaesthetic, and not every tumour, growth or patient is suitable — sometimes the surgeon needs to convert to open surgery during the operation for safety.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Keyhole (VATS) compared with open surgery
| Feature | Keyhole (VATS) | Open (thoracotomy) |
|---|---|---|
| Cuts | Small | One large cut between the ribs |
| Pain after surgery | Usually less | Usually more |
| Hospital stay | Often shorter | Often longer |
| When preferred | Many early or smaller cases | Larger, central or complex cases |
For suitable early-stage lung cancer, cancer outcomes are similar. The right approach depends on the tumour, your anatomy and the surgeon's judgement.
Preparing for your surgery
- Ask whether your operation can be done by keyhole and what would make open surgery safer for you.
- Expect tests of your heart and lung function to confirm you can tolerate surgery.
- Understand that the surgeon may need to convert to open surgery during the operation, and agree to this in advance.
- Tell the team about all medicines, especially blood thinners, and ask which to pause and when.
- Stop smoking as early as possible to reduce breathing and wound problems.
- Arrange a lift home and some help for the first days, and book time off work.
What happens
VATS is done under general anaesthetic, usually with a tube that lets the lung being operated on be deflated while the other lung keeps you oxygenated. The surgeon makes one or a few small cuts between the ribs, passes in a camera and instruments, and carries out the operation watching a screen.
What is removed or treated depends on the procedure — for example a lobe, a wedge, the lung lining, or a biopsy. Tissue is sent to the laboratory. One or more chest drains are usually placed to remove air and fluid and help the lung re-expand.
You wake in a recovery area or high-dependency unit. Good pain relief, breathing exercises and early walking with a physiotherapist start soon afterwards. If the surgeon cannot complete the operation safely by keyhole, they will convert to an open cut.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A large, central or locally invasive tumour that cannot be removed safely by keyhole.
- Dense scarring or adhesions in the chest from previous surgery or infection.
- You are not fit enough for a general anaesthetic and chest surgery.
- An emergency where open access is faster and safer.
- A situation where the surgeon judges open surgery gives a better or safer result.
Delay surgery if…
- You have an active chest infection or are unwell.
- Staging or lung-function results are incomplete.
- You are still smoking and could benefit from stopping first.
- Blood-thinning or other medicines need adjusting.
- Your heart rhythm or other conditions are unstable.
Alternatives to discuss
- Open surgery (thoracotomy) for the same operation when keyhole is not suitable.
- Robotic-assisted surgery where available and appropriate.
- Stereotactic radiotherapy (SABR) for some early cancers in people unfit for surgery.
- Image-guided biopsy if only a diagnosis is needed.
- Non-surgical treatment decided by the MDT for more advanced disease.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Smaller cuts and usually less pain than open surgery
- Often a shorter hospital stay and quicker return to activities
- Similar cancer outcomes to open surgery for suitable early-stage lung cancer
- Less disruption to the chest wall muscles and ribs
- Smaller scars than a single large open incision
Risks & complications
- Pain at the small wounds and drain sites for a few weeks
- Air leak from the lung, keeping the chest drain in longer
- Tiredness and some breathlessness on exertion
- Numbness or altered sensation near the cuts
- Conversion to open surgery during the operation
- Chest infection needing antibiotics
- An abnormal heart rhythm such as atrial fibrillation
- Fluid collecting around the lung needing drainage
- Major bleeding needing a return to theatre or transfusion
- Injury to nearby structures such as a blood vessel or the airway
- Serious breathing difficulty needing intensive care
- Death — the underlying operation, not the keyhole approach, mainly determines this risk
Most of the serious risk comes from the operation being done (for example a lobectomy or pneumonectomy) rather than from the keyhole approach itself. The main approach-specific point is conversion to open surgery, which happens in a minority of cases for safety — for example bleeding or dense scarring. Ask your surgeon how often they convert and what would prompt it for you.
Published figures to discuss
Because VATS is an approach rather than a single operation, most outcome figures relate to the procedure performed (see the lung resection and wedge resection guides). The approach-specific number that matters most is the chance of converting to open surgery, which varies with the surgeon, the operation and patient factors.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Conversion from keyhole to open surgery | Reported in a minority of cases, varying widely by operation, tumour and surgeon | Often prompted by bleeding, dense adhesions or a difficult tumour; converting for safety is good practice, not a complication of the technique itself. | VATS vs open thoracotomy for lung cancer (EJCTS review)academic.oup.comSource-linked context |
| Operative death (driven by the underlying operation) | Below about 2% overall for lung resection, higher for pneumonectomy, lower for wedge resection | Determined mainly by how much lung is removed and by fitness, not by the keyhole approach; see the lung resection guide. | VATS vs open thoracotomy for lung cancer (EJCTS review)academic.oup.comPublished figure |
| Atrial fibrillation after lobectomy | Around 10–20%, similar whether keyhole or open | The keyhole approach does not clearly reduce this particular complication. | VATS vs open thoracotomy for lung cancer (EJCTS review)academic.oup.comPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery after keyhole surgery is usually quicker than after open surgery, with less pain and a shorter hospital stay, but it still depends mainly on which operation was done. Many people are home within a few days and back to most activities within a few weeks.
- Tiredness that improves over a few weeks
- Discomfort, numbness or tingling around the small wounds and drain site
- Mild breathlessness on exertion that settles
- A cough or feeling of needing to clear the chest early on
- Less pain than people often expect from chest surgery
Aftercare
- Take pain relief as advised so you can breathe deeply, cough and walk.
- Do your breathing exercises and increase walking gradually.
- Keep wound and drain sites clean and dry and follow showering advice.
- Avoid heavy lifting and driving until your team says it is safe.
- Do not smoke, and ask for support to stop if needed.
- Watch for infection, increasing breathlessness or wound problems and report them.
- Attend follow-up and, for cancer, ask what the pathology showed and what comes next.
- Pain relief understood and collected
- Breathing-exercise and walking plan from the physiotherapist
- Help at home for the first few days
- Lift home and no-driving period understood
- Time off work booked
- Clinic and out-of-hours contact numbers saved
- Follow-up appointment and any results discussion arranged
Scars and how they heal
VATS leaves one or a few small scars between the ribs plus a drain-site mark, usually fading well over months. A single-port (uniportal) approach leaves one slightly longer scar. If the surgeon converts to open surgery, you will have a larger thoracotomy scar instead. Numbness or altered sensation near the scars is common.
⚠ Get urgent help if…
- Worsening breathlessness or you cannot catch your breath
- Chest pain, a fast or irregular heartbeat, or feeling faint
- Fever, increasing cough, or green or bloody phlegm
- Coughing up blood
- A red, hot, swollen or painful calf, or sudden breathlessness (possible clot)
- Spreading redness, swelling or discharge from a wound
- Air bubbling or leaking from a drain site
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
What counts as a good result depends on the operation. For a lung cancer, it means the tumour is removed with an adequate margin, with the final type and stage confirmed by the laboratory and the MDT. For pleural or diagnostic procedures, it means the fluid or air is controlled or a clear diagnosis is obtained.
The keyhole approach itself does not change whether a cancer is cured — that depends on the disease and the operation done. As with all cancer surgery, removing what is visible cannot guarantee that no disease remains, so follow-up and sometimes further treatment are part of the plan.
Durability depends on the operation and the condition treated, not on the keyhole approach. For early-stage lung cancer, VATS gives cancer outcomes similar to open surgery in studies, with the advantage of an easier recovery. Follow-up is the same as for the equivalent open operation.
Combining with other procedures
VATS is the way many chest operations are delivered, so it is often combined with lymph-gland sampling, pleural procedures or biopsies at the same time. Decisions about further treatment after cancer surgery are made by the MDT based on the pathology.
Follow-up & long-term care
Follow-up depends on the operation. For cancer, expect clinic reviews and scans over several years. For pleural or diagnostic surgery, follow-up confirms the problem is controlled and discusses the results. Report new breathlessness, chest pain or wound problems between appointments.
- Keep up gentle activity and breathing exercises during recovery
- Stay smoke-free and accept stop-smoking support if needed
- Attend follow-up appointments and any scans
- Report new chest symptoms promptly
Revision and secondary surgery reality
- Conversion to open surgery during the operation is the main approach-specific event, done for safety.
- Air leak, bleeding or other complications are managed as they would be after open surgery.
- Whether a cancer needs further treatment is decided by the MDT on the pathology, regardless of approach.
- Re-operation rates relate to the procedure performed rather than to keyhole versus open.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Early physiotherapy with breathing exercises and supported walking.
- A clear, written pain-relief plan so you can breathe deeply and cough.
- A named contact and out-of-hours route for breathlessness, infection or wound problems.
- A planned discussion of results and, for cancer, any further treatment with the MDT.
- Follow-up appropriate to the operation done, with scans where the indication is cancer.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The underlying operation being done (for example wedge, lobectomy or pleural surgery)
- Surgeon and anaesthetist fees
- Theatre time, any high-dependency care and length of stay
- Specialist equipment used for the keyhole approach
- Pre-operative tests and staging where relevant
- Laboratory analysis of any tissue removed
- Follow-up appointments and scans under a separate plan
- Surgeon and anaesthetist fees
- Theatre, ward and any high-dependency costs
- Length-of-stay assumptions and what happens if you stay longer
- What is covered if the operation is converted to open surgery
- Pre-operative tests and staging where relevant
- Laboratory (histology) reporting
- Follow-up appointments, scans and cover for complications
On the NHS? Keyhole (VATS) surgery is widely used in the NHS where clinically suitable; private care may be used for speed or choice of surgeon, but suitability for keyhole depends on the operation and the individual, not on funding.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting keyhole as without risks or always better, rather than usually easier to recover from.
- Not explaining that the operation may be converted to open surgery, and consenting for that.
- Implying the approach changes the chance of curing a cancer when the operation determines that.
- No discussion of the underlying operation's specific risks (see the resection guides).
- No clear instructions for air leak, infection or other common problems.
Marketing red flags
- Marketing keyhole or single-port surgery as scarless or usually not painful.
- Claiming every tumour or patient is suitable for keyhole.
- Promising cure based on the technique rather than the disease and operation.
- Presenting recovery as effortless when it is still major surgery.
- Volume or 'pioneer' claims without discussing suitability and conversion.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Can my operation be done by keyhole, and what would make open surgery safer for me?
- How often do you convert to open surgery, and what would prompt it?
- Is the cancer outcome the same by keyhole as by open surgery in my case?
- How much less pain and how much shorter a stay can I realistically expect?
- What is the plan if there is an air leak or other complication?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is keyhole surgery safer than open surgery?
Why might my surgeon switch to open surgery?
Is VATS available on the NHS?
Will I have less pain?
How long is the hospital stay?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Lung cancer treatment NICE NG122 — Lung cancer: diagnosis and management Cancer Research UK — Types of lung cancer surgery VATS vs open thoracotomy for lung cancer (EJCTS review) VIOLET trial — VATS vs open lobectomy (NEJM Evidence) Society for Cardiothoracic Surgery (SCTS)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Lung removal surgery (lobectomy) · Wedge resection of the lung · Pleural surgery and pleurodesis · Removal of a chest (mediastinal) tumour · Aortic valve replacement