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Video-assisted thoracic surgery (VATS) is one of the main medical revolutions of the past decade. For its satisfactory performance, the following pre requisites are essential: (1) k n owledge and experience in thoracic surgery; (2) team of experienced anesthesiologists; (3) preopeative assessment of respiratory function; (4) adequate postoperativecare ; and (5) instruments specially designed for thoracoscopic surgery.
VATS is routinely performed under general anesthesia with double lumen endotracheal intubation for separate control of each lung. Insufflation of carbon dioxide must not exceed 1- 3 mm Hg. Too high pressure may cause harmful reduction of venous return and mediastinal shift with impairment of ventilation. Presence of adhesions should be determined by finger exploration of the pleural cavity. Operative ports should be placed carefully, avoiding damage to the intercostal nerves and vessels.