Video-assisted lobectomy is a minimally invasive chest surgery used to treat early-stage lung cancer. Lung cancer is the leading cause of cancer-related deaths in the United States, with approximately 180,000 new cases diagnosed yearly.
While surgical resection offers the best chance of cure for those with early-stage lung cancer, the traditional open chest approach, known as thoracotomy, typically involves a hospital stay of five to seven days with an extended recovery period at home.
Thoracic surgeons offer a less invasive surgical approach called video-assisted lobectomy for select patients with early-stage lung cancer.
Video-assisted thoracic surgery (VATS) reduces the hospital stay to about three to four days, resulting in less postoperative pain and faster recovery after lobectomy compared to the traditional open chest approach.
What Is Lobectomy?
Lobectomy is a surgical removal of a large portion of the lung.
Lobectomy is the most common surgery performed to treat lung cancer.
Lobectomy is traditionally performed during a procedure called thoracotomy. During thoracotomy, an incision is made on the side of the chest between the ribs. The ribs are then spread apart to allow the surgeon to access the chest cavity and remove the tumor or affected tissues.
What Tests Are Required Before Video-Assisted Lobectomy?
If lung cancer is detected, further tests will be performed to determine whether cancer cells have spread from one or both lungs to other body parts.
Your doctor needs to know the stage of the disease to plan your treatment. Typically, preoperative tests take about a day and are scheduled several weeks before the surgery date. Your thoracic surgeon will determine the surgery schedule and include the required tests and consultations.
Generally, after your initial meeting with your surgeon, all preoperative tests are scheduled for one convenient visit.
Preoperative tests may include:
– A complete physical examination.
– Chest X-rays.
– Computed tomography (CT) scans.
– Positron emission tomography (PET) scans.
– Blood tests.
– Electrocardiogram (ECG) or a stress test.
– Respiratory tests, such as spirometry or lung function tests.
Your surgeon will determine if any additional tests are needed before surgery.
As part of your preoperative evaluation, you will meet with an anesthesiologist to discuss anesthesia and pain control after the surgery.
What Happens During Video-Assisted Lobectomy (VATS)?
Video-assisted lobectomy is considered less invasive than traditional thoracotomy.
During video-assisted lobectomy, three small incisions, each about 1 inch long and one incision measuring 3 to 4 inches, are made in the chest to provide access to the chest cavity without spreading the ribs.
During video-assisted lobectomy, a small video camera called a thoracoscope and surgical instruments are inserted into the incisions. The thoracic surgeon is guided by images of the surgical area relayed from the thoracoscopic camera while performing the lobectomy. These images are displayed on a computer screen placed next to the patient.
The surgeon removes the tumor or affected lung tissues through small incisions. In the case of early-stage cancer, lymph nodes (small bean-shaped structures) in the mid-chest area may also be removed, or a sample may be taken to ensure that the cancer has not spread to them.
Before completing the procedure, the surgeon checks for any bleeding areas, washes the chest cavity, and closes the small incisions. After surgery, one or two drains are left in place to remove excess fluids and air from around the lung. The drains are typically removed later during the patient’s recovery period.
Recovery and Future Expectations
Typically, your hospital stay after video-assisted lobectomy is 3 to 4 days after the surgery. Your thoracic surgery team, including the surgeon, surgery residents, fellows, surgical nurses, social workers, and anesthesiologists, will assist you in recovering as quickly as possible.
During your hospital recovery, you and your family will receive information about your progress to know when you can return home.
Your healthcare team will provide specific instructions for recovery and returning to work, including activity guidelines, driving, wound care, and dietary recommendations. 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 strenuous activities within 6 to 12 weeks after surgery.
A follow-up appointment will be scheduled 7 to 10 days after surgery. You will undergo a chest X-ray, and the surgeon will assess your wound site and healing. The surgeon will provide additional guidance regarding your activities, return to work, and dietary plan.
Patients who qualify for video-assisted lobectomy may vary but typically include those in need of various diagnostic or treatment procedures for the external area of the lung. The best candidates for video-assisted lobectomy are patients in the early stage of non-small cell lung cancer (small primary tumor, less than 3 cm, in stage I, where it has not spread beyond the lungs) or patients with single lung cancer in addition to enlarged lymph nodes.
Despite considering the least invasive methods for each patient, some individuals may not qualify for video-assisted lobectomy. Traditional thoracotomy may be more suitable for certain patients with larger tumors involving lymph node involvement.
There are risks associated with any surgical procedure. Your doctor will discuss the potential risks of the procedure with you. Potential risks for this procedure may include:
– Risk of bleeding requiring chest re-opening (thoracotomy).
– Persistent air leakage from the lung (more than seven days).
– Subcutaneous emphysema (air or gas in the tissues beneath the skin).