The Lung Cancer Institute Video Assisted Thoracoscopic Surgery (VATS). Video Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgical procedure used to access the chest cavity to operate on the lung, mediastinum, pleura, and esophagus. Compared to the more traditional, open approach know as a thoracotomy, VATS avoids large, rib spreading incisions that cause significant postoperative pain. VATS ultilizes small incisions within the rib spaces without the need for soft tissue or rib spreading which results in less postoperative pain, quicker time to ambulate, and decreased length of hospital stay. VATS is utilized as a diagnositc and therapeutic approach to treat many conditions such as lung and esophageal cancer, as well as benign conditions such as pneumothorax, infection (empyema), and cysts.