VATS decortication is a surgical procedure used to remove thick fibrous tissue or adhesions from the surface of the lung and pleural cavity. These layers can restrict lung expansion and function. Using video-assisted thoracoscopic surgery, the surgeon inserts a camera and fine instruments through small incisions in the chest wall to carefully peel away the fibrous layer without a full thoracotomy.
This surgery is primarily indicated in chronic empyema, where infection and pus formation lead to the development of a fibrous peel encasing the lung. It is also used in cases of pleural hemorrhage, tumors, or long-standing inflammation causing adhesions. The main goal is to free the lung from restrictive layers and restore its full expansion and respiratory capacity.
In early stages of pleural infection, fluid drainage or simple thoracoscopy may be sufficient. However, when dense fibrous membranes develop, decortication becomes necessary. It allows the removal of the fibrous shell from both the lung surface and chest wall, significantly improving respiratory mechanics and preventing long-term complications such as fibrothorax.
Following the procedure, a chest tube is placed for fluid and air drainage, and imaging is performed to ensure full lung re-expansion. Patients are encouraged to perform daily breathing exercises and may require pulmonary physiotherapy to prevent recurrence of adhesions. Lung function typically improves gradually over the following weeks, especially with proper rehabilitation support.
