Video-assisted lobectomy as a type of minimally invasive thoracic surgery
Lung cancer is the leading cause of cancer death in the United States, with approximately 180,000 new cases diagnosed each year.
Whereas surgical removal offers the best chance of recovery for those affected lung cancer In its early stages, the traditional open chest approach (called a thoracotomy) usually requires a five to seven day hospital stay, with an extended recovery period at home.
Thoracic surgeons offer a less invasive technique called video-assisted lobectomy to selected patients as a treatment for early-stage lung cancer.
Video-assisted thoracic surgery (VATS) reduces a patient's stay in the hospital for about three to four days and the patient experiences less pain and a faster recovery after video-assisted thoracotomy compared to the traditional incisional thoracotomy approach.
What is a lobectomy?
A lobectomy is the surgical removal of a large part of the lung.
A lobectomy is the most common surgery performed to treat lung cancer.
A lobectomy is traditionally performed during thoracotomy surgery (thoracotomy means traditional surgical incision in the chest).
During thoracotomy, an incision is made on the side of the chest between the ribs.
Then the ribs separate so that the surgeon can see the chest cavity and remove the tumor or affected tissue.
Procedure details
What tests are required before a video-assisted lobectomy?
If lung cancer is found, further tests will be done to see if cancer cells have spread from one or both lungs to other parts of the body.
Your doctor needs to know the stage of the disease to plan your treatment.
Preoperative exams usually last about a day and are scheduled a few weeks before surgery.
The thoracic surgery schedule will determine the dates of the tests and consultations your surgeon has requested.
Generally, after your first meeting with your surgeon, all exams are scheduled in one visit for your convenience.
Preoperative tests include:
- A complete physical examination.
- Chest X-ray.
- Computed tomography (CT).
- Positron emission tomography (PET) scan.
- Blood tests.
- Electrocardiogram or cardiac stress test.
- Breathing tests, such as spirometry or a lung function test.
Your surgeon will determine if any other tests are needed before surgery.
As part of your preoperative evaluation, you will meet with the anesthesiologist, who will discuss anesthesia and pain management after surgery.
What happens during a VATS lobectomy?
Video-assisted lobectomy is less invasive than traditional thoracotomy.
During a lobectomy using video-assisted thoracic surgery, three 1-inch and 3- to 4-inch incisions are made in the chest to provide access to the chest cavity without spreading the ribs.
During a video-assisted lobectomy, a thoracoscope (a small video camera) and surgical tools are inserted into the incisions. The thoracic surgeon is guided by images of the surgical area transferred from the thoracoscope during the lobectomy procedure. The images are displayed on a computer monitor placed next to the patient.
Side vision
The surgeon will remove the tumor or infected tissue from the lung through small incisions. If a cancerous tumor is removed in its early stages, lymph nodes (small bean-shaped structures) in the middle of the chest may also be removed or biopsied to ensure that the cancer has not spread to them.
Before the procedure is completed, the surgeon will check for any areas of bleeding, wash the chest cavity and close the small incisions. One or two drains remain in place after surgery to remove excess fluid and air from around the lung. The drains are removed later during the patient's recovery.
Recovery and future prospects
Your hospital stay after a video-assisted lobectomy is usually 3 to 4 days after surgery. Your thoracic surgery team, including your surgeon, surgical residents, colleagues, surgeons, nurses, social workers and anesthesiologist, will help you recover as quickly as possible.
While you're recovering in hospital, you and your family will receive information about your improvement so you know when you can go home.
Your health care team will provide specific instructions for recovering and returning to work, including instructions for activity, driving, wound care and diet. In general, you may be able to return to work (if you have a stable job), drive and participate in most non-strenuous activities within 4 to 6 weeks after minimally invasive chest surgery. You can resume heavy lifting and other strenuous activities within 6 to 12 weeks after surgery.
A follow-up appointment will be scheduled 7 to 10 days after the surgery. You'll have a chest X-ray and the surgeon will assess the location of the wound and your healing. Your surgeon will provide additional instructions about your activities, return to work and diet at this time.