الفهرس 
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Abstract
The term VATS should be used in the medical literature when the standaard thoracoscope is not employed in such cases the topic is separated from the surgical instrrument and the chest tube is always positioned under video control this can be achieved through a 2 cm single skin incision asingle trocar or by means of 2-3- 4- trocars and finally using a minithoracotomy of 5 to 6 cm.Video-assisted thoracoscopic surgery (VATS) is recognized as an accepted approach for many intrathoracic diseases previously requiring a thoracotomy, for a definitive diagnosis or for appropriate therapeutic management [1].VATS is principally employed in the management of pulmonary, mediastinal, and pleural pathology. [2]
In these two decades VATS has developed very rapidly, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. [3]
Surprising advances in the refinement of video technology have allowed the rapid expansion in video assisted operative approaches in nearly all surgical areas. The thoracic area is no exception and it has played a very important role in thoracoscopic surgery.
VATS not only offers bigger, more representative pleural biopsies to be undertaken, but also allows for all of the pleural surfaces (including the mediastinal, diaphragmatic, and visceral pleura) to be fully visualized and accessible for biopsy.
Using VATS enables the surgeon to diagnose less common causes of indeterminate pleural effusions without difficulty.Thoracoscopy is not a new technique; H.C. Jacobeus, the Swedish internist, was the first to perform thoracoscopy in 1910, as a diagnostic procedure for exudative pleuritis [4] utilizing a cystoscope in order to free pleural adhesions in a patient with pulmonary tuberculosis to facilitate collapse therapy [5].
H.C. Jacobeus published the first series of thoracoscopy cases in 1921, describing the value of thoracoscopy in the diagnosis of tuberculous and malignant effusions. However, in the following decades, thoracoscopy was used mainly as a therapeutic tool for adhesolysis in patients with tuberculosis (TB), in order to obtain a ‘‘therapeutic’’ pneumothorax. [4] (.After 1950, It was rarely performed due to the development of chemotherapy for patients with TB. [3]
After the decline of thoracoscopic interventions as a treatment for TB, some centres in continental Europe continued to use thoracoscopy as a diagnostic and therapeutic tool in other disorders, such as Pneumothorax and pleural effusion. Pioneers like Swierenga et al. [6] and Boutin et al. [7] confirmed its value in their publications. In the UK and the USA, thoracoscopy was not a widespread procedure, and open thoracotomy was the preferred procedure to obtain a diagnosis in pleuropulmonary disease.
Around 1990, instruments such as endoscopic stapler devices, scissors, grasping and biopsy forceps were developed for surgical interventions by means of thoracoscopy in the thorax. The development of endoscopic video systems and instrumentation lead to the widespread use, by thoracic surgeons, of therapeutic thoracoscopy for a wide variety of major thoracic procedures. [4] It is interesting that even today the abbreviation and terminology used to indicate the right mini-invasive approach are not used uniformly; in fact, some authors use thoracoscopic surgery (TS) , others video-thoracoscopy (VTS) , and others video-assisted thoracoscopic surgery (VATS). Also we found the term, medical thoracoscopy.
Thoracoscope is, by its original meaning, defined as an endoscope to observe intrathoracic space. [8]
Medical thoracoscopy is defined as a procedure performed through one hole incision, performed under local anaesthesia in the endoscopy suite with the use of a thoracoscope with a working channel for instrument as one piece, looking directly through eye piece or connected to a monitor and is generally for diagnostic purposes, at the end of the procedure the chest tube is positioned blindly in the same hole. This term (medical) is not generally accepted. [4]
Marcello Miglio & Giulio Deodato. [9] believe that there is a great difference between thoracoscopic surgery( TS) , video-thoracoscopic surgery (VTS) and Video-assisted thoracic surgery (VATS), they claim that Thoracoscopic surgery (TS) indicate the use of standard thoracoscocpe with the surgeon look directly through eye piece and instrument working through a channel in the thoracoscope .
Video-thoracoscopic surgery (VTS) should indicate the procedure that uses the standard thoracoscope connected to a camera and in turn to a video, The possible operative maneuvers with this technique are very few, such as biopsy of pleura and pleurodesis with talc; in this case the chest tube is not positioned under vision because it is generally introduced through the same incision after the withdrawal of the thoracoscope.
The term VATS should be used in the medical literature when the standard thoracoscope is not employed. In such cases the optic is separated from the surgical instrument and the chest tube is always positioned under video control. This can be achieved through a 2 cm single skin incision, a single trocar, or by means of 2-3-4 trocars and finally using a minithoracotomy of 5 to 6 cm. [9]