Robot-Assisted Thoracic Procedures

Definition

Thoracic surgery is done on the chest, but it does not involve surgery on the heart. With robot-assisted thoracic procedures, the doctor guides small robotic arms through keyhole incisions.

Thoracic Surgery

Keyhole incisions and specialized equipment are used for a robot-assisted thoracic procedure.

Reasons for Procedure

Robot-assisted thoracic procedures are considered for surgeries that:

Require precision
Do not require open access

Some thoracic surgeries that have been successfully performed using robotic techniques include:

Thymectomy —removal of the thymus gland
Lobectomy —removal of a lung lobe
Esophagectomy —removal of the esophagus
Mediastinal tumor resection —removal of tumors located in the mediastinum (the part of the chest cavity that separates the lungs)
Sympathectomy—cauterizing a portion of the sympathetic nerve

Compared to more traditional procedures, robotic-assisted surgery may result in:

Less scarring
Reduced recovery times
Less risk of infection
Less blood loss
Reduced trauma to the body
Shorter hospital stay
Faster recovery

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a robot-assisted thoracic procedure, your doctor will review a list of possible complications, which may include:

Bleeding
Infection
Collection of air or gases in the lung cavity ( pneumothorax )
Collapsed lung
Need for a prolonged artificial respiration on a ventilator (breathing machine)
Damage to neighboring organs or structures
The need to switch to traditional surgical methods (eg, traditional laparoscopic or open surgery)
Anesthesia-related problems
Nerve damage

Some factors that may increase the risk of complications include:

Advanced age
Obesity
Smoking
Diabetes
Excessive alcohol intake
Use of certain medicines

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

Physical exam
Blood tests and urine tests
Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
Pulmonary function test —a test to assess lung function
Upper GI series —x-ray of the esophagus, stomach, and part of the small intestines after swallowing a barium solution
Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
Ultrasound —a test that uses sound waves to visualize the inside of the chest
CT scan —a type of x-ray that uses a computer to create images of structures inside the chest
MRI scan —a test that uses powerful magnets and radiowaves to create images of structures inside the chest
Upper endoscopy —a lighted tube equipped with a camera is used to visualize the inside of the esophagus, stomach, and part of the small intestines

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin)
Take antibiotics if instructed.
Follow a special diet if instructed.
Take a laxative and/or use an enema to clean out your intestines if instructed.
Shower the night before using antibacterial soap if instructed.
Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

You will be connected to a ventilator. This is a machine that moves air in and out of your lungs. Next, the doctor will cut several keyhole openings in the chest wall between the ribs. One or more chest tubes may be placed into the side of the chest. These tubes will be used to drain fluid and monitor air leakage. A needle may be used to inject carbon dioxide gas into the chest cavity. The gas will make it easier for the doctor to see internal structures.

The doctor will then pass a small camera, called an endoscope, through one of the incisions. The camera will light, magnify, and project the structures onto a video screen. The camera will be attached to one of the robotic arms. The other arms will hold instruments for grasping, cutting, dissecting, and suturing. These may include:

Forceps
Scissors
Dissectors
Scalpels

While sitting at a console near the operating table, the doctor will look through lenses at magnified 3D images of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. With joystick-like controls and foot pedals, the doctor will guide the robotic arms and tools to remove organs and tissue. After the tools are removed, the doctor will use sutures or staples to close the surgical area.

Immediately After Procedure

If you are doing well, the breathing tube will be removed. Later, the chest tubes will be removed.

How Long Will It Take?

About 1-4 hours (depending on the procedure)

How Much Will It Hurt?

You will have pain during recovery. Your doctor will give you pain medicine. You may also feel discomfort from the gas used during the procedure. This can last up to three days.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is a few days. Your doctor may choose to keep you longer if you have any problems.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

Assistance sitting up and moving around soon after surgery
Instructions on what you should eat and how to restrict your activity
Nutrition through a feeding tube in the days after surgery (You will gradually progress from a liquid to a solid diet.)
Directions on how to do deep breathing and coughing exercises

At Home

When you return home, do the following to help ensure a smooth recovery:

Take antibiotics to prevent infection if instructed.
Avoid certain medicines.
Resume normal activities (eg, daily walks) soon. This will promote healing.
Wash the incisions with mild soap and water.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Limit certain activities (eg, driving, working, doing strenuous exercise) until you have recovered.
Be sure to follow your doctor's instructions.

Depending on the procedure, you should recover within a few weeks.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Cough or shortness of breath
Coughing up yellow, green, or bloody mucus
New chest pain
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
Difficulty urinating, such as pain, burning, urgency, frequency, or bleeding
Pain and/or swelling in your feet, calves, or legs
Persistent nausea, vomiting, and/or diarrhea
Headache, feeling faint or dizzy
Other worrisome symptoms

In case of an emergency, call for medical help right away.

RESOURCES

American College of Surgeons http://www.facs.org/

Society of Thoracic doctors http://www.sts.org/

CANADIAN RESOURCES

Canadian Agency for Drugs and Technologies in Health http://www.cadth.ca/

Canadian Lung Association http://www.lung.ca/

References

Esophageal cancer—esophagectomy. University of Maryland Medical Center website. Available at: http://www.umm.edu/thoracic/esoph%5Fsurgery.html . Accessed July 21, 2006.

Rea F, Marulli G, Bortolotti L. Robotic video-assisted thoracoscopic thymectomy. Multimedia Manual of Cardiothoracic Surgery website. Available at: http://mmcts.ctsnetjournals.org/cgi/content/full/2005/0324/mmcts.2004.000422 . Published March 24, 2005. Accessed July 21, 2006.

Sympathectomy. New York Presbyterian Hospital website. Available at: http://www.nyp.org/health/sympathectomy.html . Accessed May 5, 2008.

Thoracic applications. Intuitive Surgical website. Available at: http://www.intuitivesurgical.com/clinical/thoracicapplications/index.aspx . Accessed July 21, 2006.

Thoracic lobectomy. New York-Presbyterian Hospital website. Available at: http://www.nyp.org/masc/lobectomy.htm . Accessed September 16, 2009.

Thymectomy. Myasthenia Gravis Foundation of America website. Available at: http://www.myasthenia.org/information/thymectomy.htm . Accessed July 21, 2006.

Revision Information

Reviewer: Rosalyn Carson-DeWitt, MD
Review Date: 12/2011 -
Update Date: 12/30/2011 -

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