Baptist Medical News Network

 Thoracic Surgeon, Michael Koury, MD, at Baptist Medical Center in Jackson, Miss., is one of the few, if not only, surgeons in Mississippi performing video-assisted thoracoscopic surgery (VATS) lobectomy to treat lung cancer. For patients with early-stage lung cancer, this technique reduces a patient’s hospital stay to about four days from the usual seven days and the patient experiences a more rapid recovery with less pain after surgery as compared with the traditional open chest approach.

Dr. Koury has been performing the VATS lobectomy for about two years, and this procedure, which is much less invasive, is a leap forward in patient care with shorter hospital stays, less post operative pain and quicker return to normal activities.

“It is very analogous to the advances made when gallbladder surgery transitioned from an open technique to the laparoscopic technique,” Dr. Koury added. “This procedure is quickly becoming the standard of care for lung cancer surgery in the US.”

It is being promoted by Thoracic Surgeons, not only because of much better patient comfort and recovery, but also because there are less post operative complications, less cost due to decrease length of stay and in some studies better overall survival.

Traditionally, patients had to have large, painful rib-spreading incisions requiring special pain catheters for resection of the lung cancer. That is usually followed by a week-long hospital stay.  With the VATS technique, most patients do not require special post operative requirements for pain and are sent home on mild pain medications usually four days after surgery.

Dr. Koury said, “There is good data now showing that patients can obtain additional therapies such as chemotherapy quickly, if needed if they have had the less-invasive VATS lobectomy as opposed to an open standard lobectomy.”

During VATS lobectomy three incisions are made, two one inch and one 3-4 inch are made in the chest to provide access to the chest cavity without spreading of the ribs. Then, a small video camera and surgical instruments are inserted into the incisions. The thoracic surgeon is guided by the images of the operative area transmitted from the thorascope to computer monitors that are positioned next to the patient.

This procedure allows the appropriate amount of lung tissue to be removed for that particular patient, and in addition, facilitates removal of lymph nodes in different areas of the chest, which allows accurate tumor staging. Since staging is the most important factor in treatment and prognosis, subsequently, the best decision can be made about each patient’s needs for further treatment or not.

“Although minimally invasive approaches are considered for every patient, some patients may not be candidates for video-assisted lobectomy. Traditional thoracotomy may be more appropriate for some patients with larger tumors or prior chest surgery,” said Dr. Koury.

Following surgery, most patients can return to normal activities within two weeks.