Video-Assisted Thoracoscopic (VATS) Lobectomy
The University of Wisconsin Carbone Cancer Center in Madison, Wisconsin, offers a minimally invasive way to perform lobectomies called video-assisted thorascopic (VATS) lobectomy.
Treating lung cancer patients can be particularly challenging because patients may not be suitable candidates for surgery. VATS lobectomy offers an effective alternative to conventional "open" thoractomy.
The UW Carbone Cancer Center is currently one of only a few facilities in Wisconsin to perform totally minimally invasive VATS lobectomies with mediastinal lymph node resection for patients with non-small cell lung cancers less than or equal to 5 cm.
UW Carbone Cancer Center physicians has been performing VATS lobectomies since 1997 and the UW Carbone Cancer Center continues as a national leader in researching and embracing new, minmally invasive technologies to diagnose and treat lung cancer.
VATS lobectomies are best used to treat patients with stage I lung cancer tumors. Patients who have large tumors (greater than five centimeters), visible tumors inside the main airway of the lung, or whose cancer has spread to other parts of the body, may not be eligible for VATS lobectomy.
When performed on eligible patients, the VATS lobectomy procedure can effectively treat early-stage lung cancer and also offer patients less pain after surgery and a faster recovery time, with an average length of hospitalization only 2.5 days. In addition, data now show that patients can better tolerate additional therapies such as chemotherapy if they have the less invasive VATS lobectomy instead of the "standard" open lobectomy, which requires a much bigger incision and rib-spreading.
The Video-Assisted Thoracoscopic (VATS) Lobectomy Procedure
The VATS lobectomy procedure takes approximately two to three hours. Patients will be under general anesthesia.
The patient's tumor is first staged with endobronchial ultrasound (EBUS), using a tiny ultrasound placed down the windpipe (trachea) using a special bronchoscope. Next, a dedicated thoracic anesthesiologist inserts a special breathing tube into the trachea to isolate the two lungs, allowing the lung with the tumor to be passively deflated.
The surgeon then makes four incisions during the procedure: two are approximately 1 cm, one is 5mm and a 3cm "access incsision" 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 containing the tumor is then placed into a sterile bag and removed from the chest through the 3cm incision. After the lobe is removed, the surgeon removes the instruments and video camera, and closes and bandages the incisions. A small tube left for drainage is usually removed the next morning.
What to Expect after Surgery
After surgery, patients are moved to the recovery area. The breathing tube that was inserted during the operation will have been removed in the operating room. In general, patients go to the regular floor after a brief stay in the recovery room.
Most patients stay in the hospital two to three days after surgery, followed by about a week of recovery at home. Many patients can return to work within two to three weeks. While patients are in the hospital, staff follow their progress with chest x-rays and remove chest tubes once the lungs have healed.
In contrast, traditional open chest surgery requires a hospital stay of 5 to 7 days and a recovery period at home of a month or more.
Video-Assisted Thoracoscopic (VATS) Lobectomy Results
Studies show that VATS lobectomy is a safe, effective treatment for treating Stage I lung cancer. One recent study examined the safety, independence following discharge, and ability to tolerate chemotherapy following a VATS lobectomy in 153 patients. The results found:
- Average length of stay for a VATS Lobectomy was 4 days
- Two weeks following the VATS Lobectomy, 73% of patients were not using narcotics for pain control
- Of patients receiving adjuvant chemotherapy, 73% completed chemotherapy on schedule and 85% received all intended cycles of chemotherapy
(Swanson. Thoracoscopic lobectomy: Report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg, 2008;135: 642-7.)