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National percentage of thoracic surgery performed as minimally invasive video-assisted thoracic surgery (VATS), the preferred WellStar method that means less pain and faster recovery for our patients.
 

Understanding Thoracic Surgery

Thoracic surgery refers to chest surgery, most often surgery to the lungs or esophagus. Minimally invasive thoracic surgery, also called thoracoscopy or video-assisted thoracoscopic surgery (VATS), is surgery of the chest performed using a small video camera, video screen and special instruments inserted into small incisions. WellStar is pioneering this type of surgery, which minimizes trauma, the chance of infection and pain for the patient, while speeding up recovery time. In fact, surgeons from across the country are coming to us to learn how to perform this big surgery through small incisions.


Traditional thoracic surgery, known as thoracotomy, is open surgery, where a large (six to eight in.) incision is made in the chest and the surgeon uses direct vision, rather than a small camera, to perform the surgery.


Most traditional thoracic surgeries can now be performed using the minimally invasive technique, and this is the first approach that will be considered if you need thoracic surgery. However, there are some procedures that are best performed using the traditional technique. Your WellStar surgeon will carefully evaluate you to determine the safest surgical approach to treat your medical condition.


Thoracic surgeries include:


  • Pneumonectomy, which means removal of an entire lung. This surgery is most often done for lung cancer that cannot be treated by removal of a smaller portion of the lung. A pneumonectomy is an open chest technique.
  • Lobectomy, the removal of one or more lobes of the lung, is most often an open chest surgery. However, the physicians at WellStar are leading the way in the use of VATS for lobectomy.

Other procedures that can be performed using VATS include:


  • Wedge resection to remove a small, wedge-shaped portion of the lung containing cancerous cells. The surgery is performed to remove a small tumor or to diagnose lung cancer.
  • Sleeve resection is the surgical treatment of a cancer tumor of the bronchus (air passage). The cancerous portion of the bronchus is removed, and the ends of the remaining healthy segments are reconnected through sutures. This surgery keeps the surrounding healthy tissues and organs intact.
  • Esophagectomy is surgery to remove part, or all, of the esophagus, the tube that moves food from your throat to your stomach. After removal, the esophagus is rebuilt from part of your stomach or large intestine. Most of the time, esophagectomy is done to treat cancer of the esophagus.

Procedures


Before the Procedure


  • Quit smoking. Studies have shown that lung cancer surgery is more successful if people stop smoking ahead of time.
  • Your WellStar physician will run tests to rule out the spread of cancer. A lobectomy is not the preferred treatment for lung cancer that has spread beyond the lungs.
  • Pulmonary function tests will be run to evaluate your lung function to be sure you can live without a lobe.
  • Other tests, lab work and a physical will generally be performed as well to be sure you are as healthy as possible before your surgery.
  • Talk to your doctor about any medications or supplements you take. You may need to discontinue medications that can increase bleeding.
  • Your WellStar physician will recommend that you not eat or drink anything for eight hours before your surgery.

During the Procedure


  • You will be given an anesthetic to put you to sleep for the surgery.
  • A tube will be run through your mouth to allow a ventilator to help you breathe during the surgery.
  • Your WellStar surgeon will make several small incisions on your chest and side. A video camera and instruments will be inserted into the incisions.
  • Viewing your lungs on a video screen, the surgeon will tie off the blood vessels and airways to the lobe and remove it through one of the incisions.
  • One or more chest tubes may be inserted after surgery to drain your chest cavity of fluid and blood and help your lungs refill with air.
  • If the VATS procedure can’t be completed due to excessive bleeding or a tumor that can’t be removed, your surgeon may have to finish with a thoracotomy or open chest lobectomy.

After the Procedure


  • You will be monitored in a recovery room for several hours, before being moved to the intensive care unit (ICU) or a hospital room.
  • The breathing tube may remain in place while you’re in recovery, in which case you will be given medication to make you drowsy. The tube is generally removed the same day as the surgery.
  • To help keep your lungs clear and prevent inflammation, a respiratory therapist will teach you breathing exercises to do every hour or so.
  • A nurse or therapist will help you get up and walk soon after your surgery to keep your blood moving and improve healing.
  • The smaller incisions used in thoracoscopic surgery create less pain and only need band-aids for dressing.
  • You’ll have to stay in the hospital until the chest tube stops draining and can be removed, generally three to five days.

Your WellStar physician will provide complete instructions before you go home. They will likely include some of the following:


  • Do not drive for a week or so, or until pain medications are no longer needed
  • Walk some every day, if you are able, to keep your blood moving and strengthen your muscles. Start out just walking around your yard and build from there.
  • Avoid strenuous activity and heavy lifting for several weeks
  • Continue to do the breathing exercises the respiratory therapist taught you
  • Resume sexual relations when you feel ready
  • Talk to your doctor when you can go back to work
  • Take your pain medications as prescribed to help relieve soreness and make activity and deep breathing easier
  • Follow up with your doctor, who'll monitor your healing and discuss the results of the procedure