VATS Lobectomy: New Minimally Invasive Option for Lung Cancer Patients
Treating lung cancer patients can be particularly challenging because not all patients can tolerate standard surgery due to poor lung function or co-morbidities. A novel technology offered by surgeons at UW Hospital and Clinics, Video Assisted Thoracoscopic (VATS) lobectomy, offers an effective alternative to conventional "open" thoracotomy.
UW Carbone Cancer Center (UWCCC) surgeons are among only a few in Wisconsin who perform totally minimally invasive VATS lobectomies with mediastinal lymph node resection for patients with non-small cell lung cancers less than or equal to five centimeters.
UW Health physicians have been performing VATS lobectomies since 1997 and UWCCC continues to be a national leader in researching and embracing new, minimally-invasive technologies to diagnose and treat lung cancer.
Historically, patients had to have large, painful incisions and rib-spreading that required special pain catheters and hospital stays of five to seven days. With the VATS technique, the average length of hospitalization for a lobectomy at UW Hospital and Clinics is now only two and one-half days, with many patients needing only Tylenol for pain on discharge. There is good data now showing that patients can tolerate additional therapies (such as chemotherapy, if needed) better if they have had the less-invasive VATS lobectomy as opposed to an open "standard" lobectomy.
Tracey Weigel, MD, professor and chief of thoracic surgery at UW Hospital and Clinics and a member of UWCCC, performs VATS lobectomies at UW Hospital and Clinics along with James Maloney, MD, assistant professor of surgery. The surgery takes about three hours. With the patient under general anesthesia, the tumor is first staged with endobronchial ultrasound (EBUS) by placing a small bronchoscope with a tiny ultrasound at its tip down the trachea.
Next, a special breathing tube is placed by dedicated thoracic anesthesiologists. This isolates the two lungs, allowing the lung with the tumor to be passively deflated. Three tiny incisions (five to 10 millimeters) are made on the patient's chest and a three-centimeter "access incision" is made to allow removal of the lobe of the lung with the tumor. Using video assistance, the veins and arteries feeding the lobe of the lung with the tumor are carefully dissected, isolated and divided with a special stapler. The lobe with the tumor is then placed in a sterile bag and removed through the access incision with no spreading of the ribs. A small tube is left for drainage and is usually removed the next morning.
Recovery following a VATS lobectomy generally requires a hospital stay of two to three days followed by about a week at home. Patients can usually return to work within two weeks. Traditional open chest surgery requires a hospital stay of five to seven days and an at-home recovery of a month or longer. Since the incision is only slightly more than an inch and the ribs are not spread or broken in the minimally invasive VATS lobectomy, there is significantly less pain and a faster recovery for the patient.
UW Hospital and Clinics has modeled its procedure after those done at Cedars Sinai, the medical center with the largest experience in VATS lobectomies. Dr. Weigel traveled several years ago to study with Robert McKenna, MD, chief of thoracic surgery at Cedars Sinai and the world's leading authority on VATS lobectomies.