VATS For Lung Cancer Surgery Is Better Than Traditional Technique
Richard Coffey's health was his No. 1 concern when he was faced with lung cancer surgery. But the physically fit West Bloomfield, Mich., man also felt compelled to ask his surgeon about how quickly he could get back to his regular routine.
"Is there any chance I'll be playing golf again by the end of the year?" he recalls asking Beaumont chest surgeon Gary Chmielewski, M.D.
Thanks to a newer, minimally invasive technique - "video-assisted thoracoscopic surgery" or "VATS" for short - Coffey had his surgery in late spring 2001 and was back on the links by early fall the same year.
Surgeries like Coffey's are becoming increasingly common at the Beaumont hospitals in Royal Oak and Troy as Dr. Chmielewski and other chest surgeons gain expertise in VATS.
They recently presented results of research involving 364 people who had part of their lung removed - called a "lobectomy" - due to lung cancer from 2003 to 2008 at the Southern Thoracic Surgical Association's 55th Annual Meeting.
What the surgeons found is that people who had a VATS lobectomy had fewer complications (17 percent vs. 30 percent); went home from the hospital two days sooner than patients who had traditional lung cancer surgery; and had the same cancer control.
Coffey passed his five-year surgery anniversary in 2006 - the time frame within which it would be expected to reappear - and he remains cancer-free.
When a surgeon does VATS, he makes one to three small incisions for the video camera and instruments and one slightly larger incision of up to 2 to 3 inches to remove the cancerous part of the lung. This compares with an incision in traditional lobectomy that wraps around the side of the torso to the patient's back and cuts through all the muscle layers.
As the evidence mounts that VATS is more beneficial for patients and the surgeons' skill with it grows, they are using the sophisticated technique for increasingly complex surgeries involving the lung or esophagus.
"Now I'm using it even when there are adhesions (scars), a history of previous chest surgery, and enlarged lymph nodes," says Dr. Chmielewski. "Essentially the only thing that would rule out VATS is a tumor too large to remove through such a small incision or one that requires a chest wall resection to remove it."
Robert Welsh, M.D., chief of thoracic surgery who performs VATS and who participated in the research, says: "With an aging population requiring more chest surgery and fewer doctors choosing our specialty, the safe adoption of new techniques is a challenge. What our research shows is that even experienced surgeons who are not formally trained in advanced techniques can become skilled at VATS. Because of the benefits of minimally invasive surgery for patients we utilize these techniques in our patients who require lung or esophageal surgical interventions whenever possible"