The Future of Invasive Thoracic Surgery – Advancements and Predictions

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The future of invasive thoracic surgery will be marked by the increased adoption of minimally invasive techniques. Improved training and educational tools for established surgeons will be essential to achieve this goal.

Minimally invasive surgical procedures reduce trauma and infection while preserving the quality of life for patients. They also allow for easy conversion to open surgery if any problem arises.

Minimally Invasive Lung Resection

Lung resection, or removal of part or all of a lung, is a common surgery to treat lung cancer. It can be done using either open surgery with a large incision or minimally invasive surgery involving a few small incisions.

Researchers have found that video-assisted thoracoscopic (VATS) and robotic-assisted thoracic surgery, which use long tools with special cameras to view inside the lungs, are safe and effective. They offer many benefits over traditional open thoracotomy, including smaller incisions, better cosmesis, less pain, faster recovery, and a lower mortality rate.

But there are concerns about the pitfalls of VATS and robot-assisted surgery, such as leaving some cancer cells behind or under-staging a patient’s disease, which may impact their survival. 

Robotic Assisted Lung Resection

For some people, a surgeon like Armen Parajian may recommend robotic-assisted thoracic surgery, which is a way to remove a lung lobe or section of the lungs through very small incisions in the chest. This technique can lead to better recovery, less pain, and less scarring.

A thoracic surgeon inserts a camera and miniature surgical instruments into the area of lung cancer. The camera transmits the 360-degree view of the surgical field to a console that controls the movements of the surgical instruments inside the body.

The surgeon makes hand movements on the console, which the robot translates into tiny movements by the surgical instruments. This allows for more accuracy, greater ranges of motion, and precise instrument movement. This technology is used for lung cancer resections, including lobectomy (removing the lobe), segmentation, and wedge resections. 

Lung Volume Reduction Surgery

Lung Volume Reduction Surgery (LVRS) is a surgical option for patients with severe emphysema who cannot respond to medical therapy. The surgery reduces the size of the over-expanded lung to allow it to function more efficiently. This improves your breathing and allows the rib cage and diaphragm to return to normal shape.

LVRS is usually done when diagnosed with end-stage COPD (chronic obstructive pulmonary disease). The condition is estimated to affect about 12 million Americans, but many more people are not yet diagnosed.

A doctor will evaluate you to determine if you are a good candidate for LVRS. This involves a series of tests, including breathing, chest CT scans, and arterial blood gas.

The goal of LVRS is to remove the most diseased areas of the lungs, which typically results in removing about 20-30% of lung tissue. This enables the remaining lung to function more effectively and improves your quality of life.

Lobectomy

In modern thoracic surgery, the lobectomy technique has been the most successful approach in treating patients with lung cancer. However, it is still a valuable treatment option for patients with other conditions, such as tuberculosis and trauma.

Although a lobectomy can cure lung cancer, the operation is invasive and requires significant recovery time. It may also cause some side effects, such as pain and shortness of breath.

For people with non-small cell lung cancer (NSCLC), a lobectomy offers the best chance of a cure. It can be performed through a traditional thoracotomy or less invasive using a minimally invasive surgical technique called video-assisted thoracoscopic surgery (RATS) or video-assisted thoracoscopic lung surgery (VATS).