What is minimally invasive thoracic surgery?
Minimally invasive thoracic surgery is chest surgery that is performed using several small incisions and special instruments. This type of surgery is also called thoracoscopy (thor-uh-KOSS-kuh-pee) or thoracoscopic (thor-uh-co-SKAH-pick) surgery. You may also hear the surgery referred to as pleuroscopy (plur-AH-skuh-pee) or VATS (short for video-assisted thoracic surgery).
How is minimally invasive thoracic surgery done?
The surgeon makes three small (about an inch) incisions to use during the surgery. A thorascope is a small tube with a tiny camera, light and eyepiece so the surgeon can see inside the chest. The thorascope and surgical instruments are inserted into the incisions, and pictures of the chest are sent from the thorascope to a computer screen.
How does minimally invasive thoracic surgery compare with traditional thoracic surgery?
There are several differences between minimally invasive and traditional thoracic surgery. Minimally invasive surgery involves:
- Smaller incisions (traditional surgery uses a 6- to 8-inch incision).
- Shorter hospital stay.
- Less pain after surgery.
- Faster recovery and return to work.
- Other possible benefits include less risk of infection and less bleeding.
Who is a candidate for minimally invasive thoracic surgery?
Minimally invasive surgery is the first consideration for all Cleveland Clinic patients who need thoracic surgery. But, not all thoracic procedures can be done this way. About 75% of thoracic procedures performed at Cleveland Clinic require traditional (“open”) surgery. Your surgeon will carefully evaluate you and let you know the best and safest type of surgery for your treatment.
Types of minimally invasive thoracic surgery
Cleveland Clinic thoracic surgeons use a minimally invasive technique for the following procedures, which are explained on the next page:
- Video-assisted lobectomy.
- Wedge resection.
- Lung biopsy.
- Drainage of pleural effusions.
- Mediastinal, pericardial and thymus thoracoscopic procedures.
Video-assisted lobectomy
Lobectomy is the removal of a large section of the lung. This is the most common surgery performed to treat patients with lung cancer. A traditional thoracotomy uses an incision on the side of the chest between the ribs. The ribs are then spread apart so the surgeon can see into the chest cavity to remove the tumor or diseased tissue.
Cleveland Clinic surgeons routinely perform lobectomy using a minimally invasive approach. Three 1-inch incisions and one 3-to-4-inch incision are used. These let the surgeon reach the inside of the chest without spreading the ribs. The usual hospital stay after surgery is 3 days.
Cleveland Clinic is one of the few centers in the nation with extensive experience in video-assisted lobectomy. In addition, the surgical outcomes of video-assisted lobectomy are very similar to traditional lobectomy outcomes.
Some patients may need traditional lobectomy, depending on the size and location of the tumor.
Wedge resection
A wedge resection is the surgical removal of a wedge-shaped piece of tissue from one or both lungs. The procedure is usually done to diagnose or treat patients with small lung nodules.
Lung biopsy
A lung biopsy involves taking a small sample of lung tissue using a small incision between the ribs. The lung tissue is examined under a microscope by pathologists (doctors who are experts in blood, tissue and fluid), and may also be sent to a lab for more testing. The lung tissue is checked for diseases.
Drainage of pleural effusions
A pleural effusion is the build-up of extra fluid between the layers of the pleura – the thin membrane that covers the outside of the lungs and the inside of the chest cavity. Normally, there is very little fluid in location of incision for thoracoscopic surgery this space. The extra fluid is drained out using a tho- racoscopic procedure called thoracentesis (thor-uh- sen-TEE-sis). The fluid may be checked for possible causes of pleural effusion, such as infection, cancer, heart failure, cirrhosis or kidney disease. The surgeon may insert sterile talc or an antibiotic to keep the fluid from building up again.
Mediastinal, Pericardial and Thymus Thoracoscopic Procedures
The mediastinum (me-dee-uh-STINE-um) is the area in the middle of the chest between the lungs.
The pericardium (pare-uh-CAR-dee-um) is the membrane area around the heart.
The thymus is a small organ in the upper/front portion of the chest, under the breastbone. The thymus is part of the immune system.
Thoracoscopic techniques can be used to examine the mediastinum, pericardium or thymus, remove tissue samples or surgically remove cancerous growths in the affected area.
How can I be evaluated for minimally invasive thoracic surgery?
Please call Thoracic Surgery appointments at 216.445.6860 or 800.223.2273 ext. 56860 to schedule an evaluation with a thoracic surgeon.
When you meet with the thoracic surgeon, you will have a physical exam. The surgeon will talk to you about your treatment options and the benefits and potential risks of surgery.
You will also meet with an anesthesiologist to talk about anesthesia and pain management after surgery.
You may need to have tests done before your surgery. These can include:
- Blood tests.
- Pulmonary function test (breathing test).
- CT scan.
- Electrocardiogram.
You may also need to make an appointment with a cardiologist for a cardiac (heart) evaluation.
The thoracic surgery scheduler will make appointments for any tests or visits you need. We try to schedule all appointments on the same day for your convenience.
How long will I stay in the hospital after surgery?
The length of your hospital stay depends on the procedure you had. In general, patients who have thoracoscopic lung biopsies or wedge resections go home the day after surgery. Patients who have a VATS lobectomy usually go home 3 to 4 days after surgery.
What happens after the procedure?
Your thoracic surgery team will help you recover as quickly as possible. Your team includes your surgeon, surgical residents and fellows, surgical nurse clinicians, social workers, nursing team, case managers, anesthesiologist and other specialists. You and your family will receive updates about your progress so you’ll know when you can go home.
You will get specific instructions about your recovery, including activity guidelines, driving, incision care and diet.
Follow-Up Appointment: You will see your surgeon 7 to 10 days after your surgery to check your incisions and recovery progress.
Most people who have minimally invasive thoracic surgery can return to work within 3 to 4 weeks.
