SURGICAL INTERVENTION
Surgical Approaches to the Lungs
In these paragraphs, we describe methods by which Thoracic Surgeons perform the removal of lung cancer.
It is important to emphasize that in the proper conduct of surgery, what matters in treatment is the appropriate cancer operation, in other words the complete removal of the cancer with the corresponding part of lung and sufficient number of lymph node stations to allow an accurate pathologic staging.
Thoracotomy
Thoracotomy is performed in the operating room under general anesthesia. The surgeon makes an incision between the ribs to access the lung and remove the tumor, surrounding tissue, and nearby lymph nodes. After surgery a tube is placed to remove fluid and air from around the lung. Once fluid drainage decreases and there is no air leakage, the tube can be removed. Typically, the patient stays in the hospital for 5 to 7 days and then recovers at home.
VATS - Video-Assisted Thoracoscopic Surgery
Thoracoscopic surgery, also known as video-assisted thoracic surgery (VATS), is a minimally invasive surgical procedure performed under general anesthesia. Small incisions are made through which small instruments are inserted to perform the operation. The procedure requires significant technical skill and should only be performed by an experienced and specialized thoracic surgeon. During the surgery, a small camera is inserted through a small incision in the side of the chest. The image inside the thoracic cavity is transmitted to a high-resolution screen in the operating room. The surgeon can perform complex maneuvers while monitoring the image on the screen. One or two additional small incisions are made to accommodate thin instruments.
Because only small incisions are required in VATS, postoperative pain is reduced, and recovery is faster. For most VATS procedures, chest tubes are required, and patients usually stay in the hospital for a few days until fluid and air drainage subsides. Research has shown that the healing rate after VATS is superior to that of thoracotomy. The advantages of VATS include reduced overall pain, fewer postoperative complications, shorter hospital stay, rapid return to daily activities, and the ability to complete adjuvant chemotherapy when needed, compared to the classic open thoracotomy.
Robotic Thoracic Surgery
Robotic thoracic surgery is another form of minimally invasive surgery. The surgeon operates at a console inside the operating room, using robotic arms to manipulate surgical instruments. Robotic surgery requires specialized training and expertise. The outcomes from robotic thoracic surgery for lung cancer can be compared to those of VATS thoracic surgery.
