Minimally Invasive Thoracic Surgery

What Is Minimally Invasive Surgery?

Minimally invasive thoracic surgery is a way of performing surgery in the chest through small incisions, without making large cuts or incisions in the body, and does not require spreading apart of the ribs. Surgeons use a camera and instruments to get to the lung through small incisions in between the ribs. There are two different options available for minimally invasive thoracic surgery; video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgery.

Video-assisted thoracoscopic surgery (VATS) is a procedure in which a small tube called a thoracoscope is inserted through a small incision between the ribs. At the end of the tube is a small camera. This lets the surgeon see the entire chest cavity without having to open up the chest or spread the ribs. The surgeon then removes lung tissue with specially designed instruments inserted through one or two additional small incisions.

In robotic-assisted surgery, a surgeon will sit at a console next to the patient in the operating room and control the instruments, including a camera, on the robotic surgical system. A small 3D high definition camera is placed through one of the small incisions to provide a good view of the inside of the chest cavity, while wristed robotic instruments are inserted through the other small incisions made in between the ribs. The surgeon removes lung tissue through one of the small incisions. The use of the wristed instruments lets the surgeon perform the surgery without having to make larger incisions to open up the chest or spread the ribs.

What to Expect

• Your surgery will begin with you being placed under general anesthesia.
• Once you are asleep, a breathing tube is placed into your airway to allow each lung to be separately inflated during surgery.
• You are then positioned on your side.
• The surgeon then makes one to five small incisions, each about an inch wide, in between your ribs. The surgeon inserts the camera and VATS or wristed robotic instruments between the ribs.
• At the end of the surgery, the surgeon will insert a chest tube through one of the small incisions to drain extra fluid or air leaking into the chest and help your lungs to re-inflate. This tube remains in place for a few days and is typically removed at the bedside before you go home.
• Recovery time is generally shorter after minimally invasive surgery compared to open surgery, but you will still need time to rest and recover. Once home, most patients will regain most of their strength, energy and breathing after two to three weeks.

What Are the Risks and Benefits?

Like all surgery, there are risks to minimally invasive thoracic surgery. They include infection, bleeding, abnormal heartbeats and air leakage from your lungs and pain. Robotic-assisted surgery may be associated with longer operative times and a longer time under anesthesia. Your surgeon may have to convert to a more invasive approach if needed to complete the surgery.

However, there are benefits to minimally invasive surgery compared to open chest surgery through a thoracotomy, depending on which minimally invasive approach you receive you may experience:

• Faster recovery and return to normal activities
• Fewer complications
• Shorter hospital stay
• Less pain and decreased need for pain medications
• Smaller scars
• Less blood loss
• No cutting of the ribs or breastbone (sternum)

Each person handles surgery a little differently and your outcomes may depend on a number of factors, like your health history, the type of lung cancer you have and/or your surgeon's experience.

Who Is Eligible?

Surgeons evaluate whether each patient is a candidate for minimally invasive thoracic surgery on a case by case basis. Surgeons consider the patient's specific condition, medical history and anatomy when deciding if they are eligible for minimally invasive surgery. Talk to your doctor about whether this type of surgery is right for you.