More than one million thoracic surgical procedures are performed in the United States every year to treat heart and lung diseases, cancer, nerve disorders, and other conditions. For the past several years, a new minimally invasive procedure called video-assisted thoracoscopic surgery, or VATS, has been used to reduce postoperative pain, decrease hospital lengths of stay, and return patients to normal activities more quickly.
Nearly 400 thoracic surgical procedures were performed at Baystate last year. More thoracic procedures can be performed thoracoscopically, and we expect the surgical volume to increase as more patients and referring physicians become aware that these procedures are offered at Baystate. We are currently the only hospital in Western Massachusetts performing these advanced thoracoscopic procedures.
Traditional Procedure vs. VATS
While thoracoscopies were first performed in 1910 to diagnose pleural diseases, applications for the procedure were limited until the introduction of video-endoscopic instruments in the late 1980s.
Traditionally, patients requiring thoracic surgery faced a long and difficult recovery following “open” surgical procedures. In most of these cases, a long incision was made through the chest muscles, and the ribs were cut or spread to allow the surgeon to reach the diseased area. These patients required a hospital stay of up to a week and about a four- to six-week recovery period at home before they could resume normal activities.
VATS enables surgeons to perform common thoracic procedures using minimally invasive techniques. Depending on the particular type of surgery required, two to four small incisions – about ¼ inch to 3 inches long – are made on the patient’s side. A small endoscope is inserted through the first incision and certain anatomic landmarks are identified. Magnified images are projected onto a monitor for the surgeon, who uses special instruments inserted through the remaining incisions to treat affected areas.
With this technique, we can not only remove portions of the lung, but we can also operate on the esophagus, diaphragm, chest wall and mediastinum. The primary advantages of VATS over open surgery are reduced postoperative pain and faster return to work and resumption of normal activities.
Over the past decade, more surgeons have been trained in the VATS technique, and many surgeons are now publishing results showing favorable outcomes with the newer, more advanced VATS methods. Published outcomes have shown similar, if not superior, results for most VATS procedures, and patients are grateful that we are able to reduce their pain and get them back to work and their routines sooner.
Treatment for a Number of Conditions
Surgeons at Baystate Medical Center use minimally invasive thoracic surgery to treat a variety of medical conditions. These include resections for lung cancer and benign lung tumors; lung biopsies; treatment for empyema, malignant pleural effusions, and pneumothorax; endoscopic thoracic sympathectomy for palmar hyperhidrosis; and benign esophageal and mediastinal tumors.
“Minimally invasive thoracoscopic surgery represents an important enhancement to our patient care,” says Wilson C. Mertens, MD, medical director of the Baystate Regional Cancer Program. “Our ability to offer patients state-of-the-art cancer treatment and symptom palliation rounds out the multidisciplinary approach to thoracic malignancies we have developed at Baystate.”
While all surgical procedures carry with them some risk, the majority of patients tolerate minimally invasive thoracic procedures without any difficulty. Because one lung is collapsed during the procedure to allow for visualization through the scope, patients who cannot adequately maintain oxygenation with the remaining lung are not candidates for these procedures.
For more information about VATS or to refer a patient, please call Baystate Thoracic Surgery at 413-794-8050. To learn more about the Baystate Regional Cancer Program, call 413-794-2727 or visit baystatehealth.com/brcp.