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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
Laparascopic Thoracic
Keyhole incisions and specialized equipment are used for a robot-assisted thoracic procedure.
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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, which is 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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Collection of air or gases in the lung cavity
  • Collapsed lung
  • Need for a prolonged artificial respiration on a breathing machine
  • Damage to nearby organs or structures
  • The need to switch to traditional surgical methods such as traditional laparoscopic or open surgery
  • Anesthesia-related problems
  • Nerve damage
Some factors that may increase the risk of complications include:
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:
Leading up to the procedure:
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • 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, several keyhole openings will be cut 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 internal structures to be viewed.
A small camera, called an endoscope, will be passed 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 use lenses to look 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?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. You may also feel discomfort from the gas used during the procedure. This can last up to 3 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 an IV or 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:
  • Limit certain activities, such as driving, working, doing strenuous exercise, until you have recovered.
  • Wash the incisions with mild soap and water.
  • Participate in any physical therapy or rehabilitation.
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
  • Pain and/or swelling in your feet, calves, or legs
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

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

Society of Thoracic Surgeons 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

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 25, 2013.

Sympathectomy. New York Presbyterian Hospital website. Available at: http://www.nyp.org/health/sympathectomy.html . Accessed July 25. 2013.

Thymectomy. Myasthenia Gravis Foundation of America website. Available at: http://www.myasthenia.org/LinkClick.aspx?fileticket=BIVoreOXJGo%3D . Accessed July 25, 2013.

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