Download New, less-invasive lung and heart surgeries shorten

House Calls
September 12, 2005
New, less-invasive lung and heart surgeries shorten recovery time and reduce pain
By Hon Chi Suen, M.D.
Minimally invasive surgery has transformed many surgical procedures over the last
several years, dramatically reducing pain and the size of incision while shortening
recovery time for patients. Techniques that use small holes, or ports, for surgeons
to enter the body for repairs have transformed knee, shoulder and even gallbladder
surgeries. Now, new surgical procedures for chest surgery are available that no longer
require a foot-long opening that sometimes included spreading or breaking ribs to
access internal organs.
Skilled cardiothoracic surgeons are now using an exciting advancement – a much lessinvasive procedure called VATS – video-assisted thoracic surgery. Because VATS is less
invasive, recovery is much quicker — often days, rather than the four to six weeks of
traditional surgery — and the patient’s pain is reduced significantly. With VATS, there
are only several small scars and much less damage to the chest wall and muscles.
The technique was introduced about 10 years ago, but has been perfected and approved
for more general use recently.
The highly skilled VATS procedure is accomplished by putting a small scope with a
tiny video camera through a ¼” opening in the chest. The surgeon watches the scope’s
progress through internal organs on a monitor, and then surgery is performed using
miniature surgical instruments through other small openings, using the scope as a
guide.
The VATS procedure is effective in removing early lung cancers, especially for patients
who cannot tolerate an open surgery. Called a VATS lobectomy, this procedure requires
advanced skills in thoracoscopic surgery to perform because lung tissues and vessels
are very fragile. The cancerous lobe is placed in a small bag and removed through a 2”
opening without spreading the rib cage. Since introduction of this technique earlier this
year, I have completed this procedure nine times, with great success. Patients report
much less pain, easier breathing and an earlier return to normal activity.
Cardiothoracic surgeons, working with your pulmonologist, can also use VATS
techniques to:
• Perform lung biopsy to find out the cause of some lung illnesses
• Stop air leaks in patients who have pneumothorax, air collection between the
chest wall and the lung, resulting in shortness of breath
• Diagnose conditions where fluid has collected between the lung and chest wall,
and fuse the lung to the chest wall to prevent recurrence
• Remove lung nodules for diagnosis or treatment
• Reduce lung volume in emphysema patients so that they can breathe easier.
In addition to lung procedures, VATS also has been used to treat some heart conditions,
including removing fluid around the heart and placement of pacemaker leads on the
surface of the heart. VATS is also very effective for other conditions such as removing
the thymus gland to treat myasthenia gravis, a disease resulting in weakened muscles
and fatigue. For patients with excessive sweating in the hands and underarms, this
procedure can be used to interrupt the nerves responsible, instantly relieving the
condition.
My colleagues and I are now developing a new VATS technique for treatment of atrial
fibrillation, a type of irregular heart rhythm. Patients with this condition have poor
heart function and are at high risk for strokes, which require long-term medications that
can have unwanted side effects.
The benefits of VATS procedures for patients are remarkable, and as new applications
are found and additional knowledge is obtained, we can look for a day when openchest surgery is nearly a thing of the past.
Hon Chi Suen, MD, is a cardiothoracic surgeon at SSM DePaul Health Center who
specializes in heart, lung and esophageal surgical procedures. Dr. Suen can be reached
at (314) 291-1222.