Video-Assisted Lobectomy “Key-hole” Surgery
Minimally Invasive Thoracic SurgeryLobectomy and Lung Cancer
Lung cancer is the leading cause of cancer death in the United States, with approximately 180,000 new cases diagnosed each year.
While surgical resection offers the best chance of a cure for those with early-stage lung cancer, the traditional open-chest approach (referred to as a thoracotomy) typically requires five to seven days of recovery in the hospital, with an extended recovery at home.
We offer a less invasive surgical approach called a VIDEO-ASSISTED LOBECTOMY for selected patients as a treatment for early-stage lung cancer. This video-assisted thoracic surgery (VATS) technique reduces a patient’s hospital stay to about three to four days and the patient experiences a more rapid recovery with less pain after the VATS lobectomy surgery, as compared with the traditional thoracotomy approach.
We have significant experience in a video-assisted lobectomy. In addition, the surgical outcomes of video-assisted lobectomy are comparable to traditional lobectomy outcomes.
What is a lobectomy?
A lobectomy is the surgical removal of a large section of the lung and is the most common surgery performed to treat lung cancer.
Lobectomy has been traditionally performed during thoracotomy surgery. During thoracotomy surgery, an incision is made on the side of the chest between the ribs, the ribs are then spread apart to enable the surgeon to see into the chest cavity and remove any tumor or affected tissue.
What tests are needed before video-assisted lobectomy?
If lung cancer has been detected, more tests will be performed to determine if the cancer cells have spread from one or both lungs to other parts of the body (staging). Your doctor needs to know the stage of the disease to plan your treatment.
Pre-surgical tests need to be undertaken and this usually includes
- Physical examination
- Blood investigations
- Lung function tests
- Cardiac assessment
- CT/PET scan.
As part of your preoperative evaluation, you will meet with an anesthesiologist who will discuss general anaesthesia and pain control.
What happens during VATS lobectomy?
Video-assisted lobectomy is less invasive than traditional thoracotomy. During a VATS lobectomy (uniport technique), a single 4cm incision is made in the chest to provide access to the chest cavity without spreading the ribs.
During a video-assisted lobectomy, a thoracoscope (small video camera) and surgical instruments are inserted into the incision. The thoracic surgeon is guided by the images of the operative area transmitted from the thoracoscope while performing the lobectomy. The images are projected onto a computer monitor that is positioned next to the patient.
Your surgeon will then remove the tumor or affected tissue from the lung through the incision. If an early-stage cancer tumor is being removed, the lymph nodes (small, bean-shaped structures) in the mid-chest area may also be removed or biopsied to ensure that cancer has not spread.
Before completing the procedure, the surgeon will check that there are no areas of bleeding, rinse out the chest cavity and close the small incisions. Usually, one chest drain remains in place after the surgery to remove excess fluid and air from around the lung. This will usually be removed by the second day following surgery.
What happens during VATS lobectomy?
Video-assisted lobectomy is less invasive than traditional thoracotomy. During a VATS lobectomy (uniport technique), a single 4cm incision is made in the chest to provide access to the chest cavity without spreading the ribs.
During a video-assisted lobectomy, a thoracoscope (small video camera) and surgical instruments are inserted into the incision. The thoracic surgeon is guided by the images of the operative area transmitted from the thoracoscope while performing the lobectomy. The images are projected onto a computer monitor that is positioned next to the patient.
Your surgeon will then remove the tumor or affected tissue from the lung through the incision. If an early-stage cancer tumor is being removed, the lymph nodes (small, bean-shaped structures) in the mid-chest area may also be removed or biopsied to ensure that cancer has not spread.
Before completing the procedure, the surgeon will check that there are no areas of bleeding, rinse out the chest cavity and close the small incisions. Usually, one chest drain remains in place after the surgery to remove excess fluid and air from around the lung. This will usually be removed by the second day following surgery.
RECOVERY AND OUTLOOK
How long will it take to recover from video-assisted lobectomy?
Your hospital stay following video-assisted lobectomy is usually 3 to 4 days after surgery, your thoracic surgery team will help you recover as quickly as possible.
During your hospital recovery, you and your family will receive updates about your progress and the possible day of discharge.
Your health care team will then provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care, and diet.
In general, you may be able to return to work (if you have a sedentary job), resume driving, and participate in most non-strenuous activities within 4 to 6 weeks after minimally invasive thoracic surgery. You can resume heavy lifting and other more strenuous activities within 6 to 12 weeks after surgery.
A follow-up appointment will be scheduled approximately 14 days after your surgery. You will be required to have a chest x-ray done and your surgeon will assess the wound site and your recovery. The surgeon will provide additional guidelines about your activities, return to work, and diet at this time.
Frequently asked questions for video-assisted lobectomy
Which patients are candidates for a video-assisted lobectomy?
Patients who need a variety of diagnostic and/or therapeutic procedures for the outer area of the lung may be candidates for video-assisted surgery.
Although minimally invasive approaches are considered for every patient, some patients may not be candidates for video-assisted lobectomy.
Traditional thoracotomy may be more appropriate for some patients with large tumors, involved lymph nodes, or prior chest surgery.
What are the benefits of a video-assisted lobectomy?
- Patients who have video-assisted lobectomy generally experience less pain and have a quicker recovery than those who have traditional thoracotomy surgery.
- Other possible benefits include reduced risk of infection and less bleeding.
- Recent research indicated that video-assisted lobectomy can be performed with low rates of complications and reduced in-hospital recovery to approximately 3 to 4 days.
- Additional studies also demonstrate that video-assisted lobectomy is as effective in removing stage I lung cancers as compared to the traditional, open-chest thoracotomy.
What are the risks of a video-assisted lobectomy?
There are risks in every surgical procedure. Your doctor will discuss the potential risks of the procedure with you. Possible risks of the procedure may include:
- Risk of bleeding, requiring the opening of the chest (thoracotomy)
- A persistent air leak (greater than 7 days) from the lung
- Subcutaneous emphysema (the presence of air or gas in subcutaneous tissues)
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