Surgery we offer

Lung Surgery

Minimally invasive lung and chest surgery

The most common indication for lung surgery is a lung cancer in developed world. There are many other indications other than cancer to perform surgery within chest. Chest cavity includes organs other than lungs which may require surgical correction but are uncommon. Minimally invasive surgery by definition is to avoid rib spreading thoracotomy. Minimally invasive surgery utilizes mini thoracotomy which is approximately 3-4 cm in size and ribs are not manipulated resulting into less pain and early recovery after surgery.

What is rib spreading thoracotomy ?

Most common approach for carrying out lung surgery is via thoracotomy. This approach involves incision of approximately 10 cm on the chest wall. Some surgeons may make bigger incisions. The biggest advantage is that the surgeon can visualise chest cavity very well to carry out surgery but there are some major disadvantages which are chronic pain, rib fractures, nerve injuries, muscle scar and chest wall scar. It is natural to worry about the length of incision but realistically most incisions heal well but leave a sizeable scar. Rather than the length of incision, the most damaging part of this approach is requirement of spreading your ribs. The space between your ribs is only about 1 cm in most people. For surgeons utilizing this approach, they need to spread the ribs with an instrument. Ribs being rigid structure develops small cracks and sometimes fractures which are the cause of severe post operative pain. At the end of surgery, ribs are brought together with series of strong sutures which are passes around the ribs and tied. All ribs are accompanied by nerves that supplies sensation to chest wall. The spreading with instruments also is likely to damage this delicate nerves and approximating ribs with sutures causes pressure on nerves which can cause chronic pain. Chest wall has some of the strongest muscles. Large incisions across these muscles damages them and contributes to pain and difficult in taking deep breaths after surgery.

Is there a thoracotomy in minimally invasive surgery ?

Yes. But the thoracotomy is small approximately 3-4 cm. It is placed in such a way to avoid cutting through strong chest wall muscles. No instruments are used to spread the ribs hence, avoiding rib fractures and damage to nerves which in the end likely to result in less pain and early recovery. The question is how does the surgeon sees inside of chest with such a little hole. This type of approach mandates use of telescope with light source to enable surgeon to achieve vision better than standard thoracotomy approach.

What is VATS or video assisted thoracoscopic surgery ?

Video assisted thoracoscopic surgery is a type of minimally invasive lung surgery. The surgeons uses minithoracotomy which measures around 3-4 cm. The vision of surgery is assisted by introduction of telescope(hence name video assisted) from separate 1 cm incision. Some surgeons make another 1 cm incision to introduce lung holding instrument. The entire surgery is carried out from 3-4 cm minithoracotomy while using a video monitor to visualise inside of the cavity. This monitor can provide significant magnification of structure providing surgeons superior vision of structures. There is no rib spreading involved which removes all the disadvantages of standard thoracotomy.

What are the advantages of VATS approach ?

True VATS approach as described here as many advantages:

  1. Small scar
  2. No rib spreading involved hence minimal chance of injury to ribs or nerves
  3. Early recovery
  4. Less blood loss
  5. Preservation of breathing function assisting in early mobilization and recovery
  6. Less chances of chronic pain
  7. Future reoperations are relatively easier to perform

Can all thoracic surgeon perform VATS approach?

Any thoracic surgeon who want to perform VATS approach will require training and experience. Most surgeons would have trained in a centre where VATS approach is common or they do fellowship training to acquire skills.

Thoracoscopic excision of mediastinal mass (VATS)
Thoracoscopic Lobectomy
Surgery for Pnuemothorax