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What is Minimally Invasive Lung Surgery?

Lung surgery is traditionally performed through an open method, where a long incision is made along the side of the chest between the ribs. The ribs are spread apart or a rib may be removed to access the lungs for the repair or removal of diseased lung tissue. Minimally invasive lung surgery is a method of performing surgery in the chest through tiny incisions, without making large incisions or spreading apart of the ribs. Tiny cameras and miniaturized surgical instruments are used to access the lungs through small incisions in between the ribs and carry out the required repair.

Indications for Minimally Invasive Lung Surgery

Lung surgeries that can be performed through a minimally invasive approach include:

  • Lung biopsy: A biopsy is a procedure employed to remove a small piece of lung tissue for laboratory examination.
  • Lobectomy: A lobectomy is a surgical procedure in which one or more lobes of a lung are removed for early-stage lung cancer.
  • Pneumonectomy: A pneumonectomy refers to the surgical removal of the entire lung to treat advanced-stage lung cancer.
  • Wedge resection: Wedge resection refers to the removal of a part of a lobe as a treatment for early-stage lung cancer.
  • Surgery to prevent the recurrence of fluid collection between the lung and chest cavity.
  • Surgery to remove accumulated blood or infection from the chest cavity.
  • Surgical removal of small balloons of tissue called blebs, which can cause lung collapse.

Preparation for Minimally Invasive Lung Surgery

Preoperative preparation for minimally invasive lung surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Minimally Invasive Lung Surgery

Minimally invasive lung surgery can be performed with two different options: video-assisted thoracoscopic surgery (VATS) and robotic-assisted lung surgery. Both techniques make use of small surgical cuts for the insertion of a camera and miniature surgical instruments.

VATS procedure: In video-assisted thoracoscopic surgery (VATS), your surgeon will make several small incisions over your chest wall under general anesthesia. A long, thin tube (thoracoscope) with a camera attached to one end and small surgical instruments are inserted into the chest through the small incisions in between the ribs. The thoracoscope guides your surgeon visually through the surgery by projecting the internal images onto a monitor. Your surgeon then uses small surgical instruments inserted through the incisions to carry out the required repair based on the patient’s lung condition. This may also be coupled with other procedures. Once the surgery is completed, drains are placed, the incisions are closed, and you are taken to the intensive care unit for monitoring.  The drains are removed a day or two after the surgery. A VATS procedure is done to remove lung cancer or tumors, accumulated fluid, blood or blood clots, and infections from the chest cavity. They may also be used for biopsy and management of collapsed lung tissue and lung injuries.

Robotic-assisted lung surgery: The robotic system consists of a surgeon’s console, a patient-side cart with interactive robotic arms, a high-performance vision system (3D camera), and miniaturized surgical instruments. In a robotic-assisted lung surgery, your surgeon will be sitting at a console next to you in the operating room and control the instruments, including the camera, on the robotic surgical system. Under general anesthesia, your surgeon makes 3 to 4 small incisions on the sides of the chest wall in between the ribs. A small 3D high-definition camera is inserted through one of the small incisions to provide a fine view of the inside of the chest cavity, while wristed robotic instruments are placed through the other small surgical cuts. These instruments are held by robotic arms that are controlled by your surgeon at the console. The surgeon’s every move (of hands and wrists) is recognized by a computerized system that manipulates and translates them into corresponding scaled and accurate movements that are mimicked by the robotic arms. Your surgeon removes diseased lung tissue through one of the small incisions or carries out other required repairs accordingly. The utilization of the wristed instruments enables your surgeon to carry out the procedure without having to make larger cuts to open up the chest or spread the ribs apart, resulting in minimal muscle trauma.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon will prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. To maintain a healthy lung, you will be advised to take your prescribed medications and make a few lifestyle changes like quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Minimally Invasive Lung Surgery

Minimally invasive lung surgery provides various benefits against the traditional open method including:

  • Smaller scars
  • Decreased risk of infection
  • Less bleeding
  • Reduced requirement of transfusion
  • Less post-operative pain
  • Fast recovery
  • Shorter hospital stays
  • Quicker return to daily normal activities

Risks and Complications

Minimally invasive lung surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Damage to adjacent tissues or organs
  • Abnormal heart rhythms
  • Leakage of air from lungs