VATS · Robotic-Assisted · Minimally Invasive Thoracic Surgery London
Keyhole chest surgery — smaller incisions, faster recovery.
Mr Scarci specialises in video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic procedures. More than 5,000 minimally invasive operations performed at consultant level. For most patients, keyhole surgery means a 2–4 day hospital stay rather than 7–10 days with open thoracotomy.
5,000+
Minimally invasive procedures
170+
Peer-reviewed publications
2–4 days
Typical VATS hospital stay
3–4
Small incisions (vs one large)
Why minimally invasive surgery produces better outcomes
Not all surgeons perform VATS or robotic surgery — many still default to open thoracotomy. The difference in patient experience and recovery is substantial.
| Comparison | Open thoracotomy | VATS / Robotic (Mr Scarci) |
|---|---|---|
| Incision size | Single incision 15–25 cm | 3–4 small incisions of 1–3 cm |
| Rib spreading | Ribs spread apart — major source of post-op pain | No rib spreading required |
| Hospital stay | 5–10 days typical | 2–4 days for most VATS procedures |
| Post-operative pain | Significant — often requires epidural or PCA for 3–5 days | Considerably reduced — most patients on oral analgesia by day 2 |
| Return to normal activity | 8–12 weeks | 4–6 weeks for most patients |
| Surgical scar | Large curved scar around chest wall | 3–4 small scars, often barely visible at 6 months |
| Blood loss | Higher average blood loss | Lower blood loss — reduced need for transfusion |
| Risk of infection | Higher wound infection rate | Lower wound infection rate |
| Oncological outcomes | Equivalent for lung cancer | Equivalent for lung cancer — with better recovery |
Not sure if you’re suitable for keyhole surgery? Most patients are. Suitability depends on tumour size, location, and lung function — all assessed at consultation. Book a Consultation →
VATS vs robotic-assisted surgery
Video-Assisted Thoracoscopic Surgery
The most widely used minimally invasive approach. A small camera (thoracoscope) is inserted through one incision; long specialised instruments through 2–3 others. The surgeon operates watching a high-definition screen.
- Most common approach for lung resection
- Uniportal (single incision) VATS available for suitable cases
- Mr Scarci has published extensively on uniportal VATS technique
- Faster operating time than robotic for standard procedures
- Available at all four surgical hospitals
Robotic-Assisted Thoracic Surgery
The surgeon operates from a console, controlling robotic arms with wristed instruments. Provides 10× magnification and 540-degree instrument rotation, enabling precise dissection in complex anatomical locations.
- Advantages in complex hilar dissection and mediastinal surgery
- Particularly useful for thymectomy and sleeve resections
- Eliminates surgeon hand tremor
- Enhanced 3D visualisation
- Same incision size and recovery as standard VATS
Procedures available via VATS or robotic approach
Minimally invasive surgery for these conditions
The great majority of thoracic procedures can be performed via keyhole approach. Open thoracotomy remains appropriate for certain complex cases and is always discussed explicitly when relevant.
Lung cancer resection
Lobectomy, segmentectomy, wedge resection, sleeve resection via VATS or robotic approach
Pneumothorax
Bullectomy and pleurodesis for primary and secondary spontaneous pneumothorax
Pleural procedures
Pleurodesis, pleural biopsy, decortication for empyema — all via keyhole
Thymectomy
VATS and robotic thymectomy for thymoma and myasthenia gravis — avoiding sternotomy
Diaphragmatic plication
VATS plication for phrenic nerve palsy and diaphragm paralysis
Mediastinal cysts
VATS resection of bronchogenic, pericardial, and other mediastinal cysts
Lung biopsy
Diagnostic VATS wedge biopsy for interstitial lung disease and undiagnosed nodules
Sympathectomy (ETS)
Endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing
Catamenial pneumothorax
VATS pleurodesis and diaphragmatic repair for thoracic endometriosis
VATS surgery — your questions answered
The vast majority of patients are suitable for VATS. The key considerations are tumour size and location (very large or centrally positioned tumours may require open surgery or a hybrid approach), previous chest surgery causing adhesions, and overall lung and cardiac function. These are assessed at consultation with your imaging review. Mr Scarci will be explicit about which approach is planned and why.
Open thoracotomy remains the most appropriate approach for a minority of cases — centrally located tumours, complex vascular involvement, or very large masses. When open surgery is needed, Mr Scarci discusses this clearly at consultation, explains why, and ensures pain management is optimised. Oncological results for open vs VATS lobectomy are equivalent. Recovery is longer but the surgery is equally effective.
Over 5,000 minimally invasive thoracic procedures at consultant level, with more than 170 peer-reviewed publications including original research on uniportal (single incision) VATS technique. He was one of the founders of the International VATS Symposium, which brought together the world’s leading minimally invasive thoracic surgeons. His case volume and academic output place him among the most experienced VATS surgeons in the UK.
Yes, for most VATS lung resections a chest drain is placed during the operation. It is typically thinner and better-tolerated than the drains associated with open surgery. For VATS procedures, the drain is usually removed on day 2–3 once air leak has resolved and fluid output is acceptable — often the same day as or day after the drain is removed, patients are discharged home.
Keyhole surgery — when done well, it changes recovery.
A consultation with Mr Scarci will confirm whether VATS or robotic surgery is appropriate for your specific case, and what to expect from the procedure and recovery.
020 7459 4367
