Robot-Assisted Thoracic Procedures
DefinitionThoracic 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.
|Keyhole incisions and specialized equipment are used for a robot-assisted thoracic procedure.|
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Reasons for ProcedureRobot-assisted thoracic procedures are considered for surgeries that:
- Require precision
- Do not require open access
- 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
- Less scarring
- Reduced recovery times
- Less risk of infection
- Less blood loss
- Reduced trauma to the body
- Shorter hospital stay
- Faster recovery
Possible ComplicationsProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- 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
What to Expect
Prior to ProcedureDepending on the reason for your surgery, your doctor may do the following:
- Physical exam
- Blood tests and urine tests
- Chest x-ray
- Pulmonary function test
- Upper GI series
- Electrocardiogram (EKG)
- CT scan
- MRI scan
- Upper endoscopy
- 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.
AnesthesiaGeneral anesthesia will be used. It will block any pain and keep you asleep through the surgery.
Description of the ProcedureYou 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:
Immediately After ProcedureIf 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 StayThis 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 CareAt the HospitalWhile 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
- 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.
Call Your DoctorIt is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- 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
American College of Surgeons
Society of Thoracic Surgeons
Canadian Agency for Drugs and Technologies in Health
Canadian Lung Association
Rea F, Marulli G, et al. Robotic video-assisted thoracoscopic thymectomy. Multimed Man Cardiothorac Surg. 2005.
Sympathectomy. New York Presbyterian Hospital website. Available at: http://nyp.org/testsprocedures/showDocument.php?contentTypeId=135&contentId=25&heading=Sympathectomy. 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.
- Reviewer: Michael Woods, MD
- Review Date: 02/2015
- Update Date: 09/30/2013