Minimally Invasive Surgery for Lung, Mediastinal and Pleural Conditions

University of Chicago thoracic surgeons perform a variety of minimally invasive procedures for conditions of the lung, pleura and mediastinum. Compared to surgery performed through a long, open-chest incision, minimally invasive lung surgery provides several benefits for patients, including the following:

• Faster recovery and return to normal activities
• Shorter hospital stay
• Less pain
• Little scarring
• Minimal blood loss
• No cutting of the ribs or breastbone (sternum)
• Possible improved cure rates for cancer

Our team includes leaders in video-assisted thoracic surgery (VATS) and minimally invasive thoracic surgery using a robotic approach. More than half of our lung resection operations are performed using minimally invasive techniques.

• Video-assisted thoracic surgery (VATS) is a technique that involves insertion of a long, thin tube (called a thoracoscope) with a camera attached to it through a small incision, or port. The thoracoscope allows the surgeon to examine inside the chest cavity and to remove tissue using thin instruments inserted through one or two additional ports. For more extensive operations such as lung resection for cancer, an additional incision measuring about 5 centimeters is made for the removal of the lung tissue. We also perform removal of esophageal cancers using minimally invasive techniques.
• Robotic thoracic surgery is an approach that is performed with the use of the da Vinci Surgical System, a sophisticated robotic device that, like VATS, gives the surgeon access inside the chest cavity through tiny incisions. The surgeon controls the robot's movements from a nearby console in the operating room. The robotic system provides improved visualization (using three-dimensional technology), better access to mediastinal tissues, and improved ability to remove lymph nodes as part of a cancer operation.

The use of these techniques is evaluated on a case-by-case basis. Our surgeons choose the best approach for each patient, taking into account many factors, such as the patient's particular condition, medical history and anatomy.

University of Chicago thoracic surgeons offer minimally invasive diagnostic and treatment options for the following conditions, and more:

Lung Cancer

Barbara Arvia had VATS surgery for early-stage lung cancer. »Read her story

University of Chicago thoracic surgeons use either VATS, robotic or open techniques to diagnose, stage and treat lung cancer. Our surgeons regularly use minimally invasive techniques to remove nodules and tumors for an accurate and swift diagnosis. Lymph nodes in the chest are also biopsied to determine the stage of the cancer. If cancer is confirmed, the surgeon may perform one of the following procedures:

• Wedge resection: Removal of the tumor and tissue surrounding the cancer.
• Segmental resection: Removal of the tumor and surrounding anatomic structures consistent with a more complete cancer operation. This may be appropriate for very small, peripheral tumors.
• Lobectomy: Removal of the entire lobe of the lung that contains the cancerous tissue. This is the standard operation for most lung cancers.

View lung cancer care video presentations by University of Chicago thoracic surgeon Mark Ferguson, MD and other University of Chicago experts.

In many cases, minimally invasive surgery (VATS and robotic) enables patients to be discharged sooner following the operation, making the duration of the hospital stay much shorter than the traditional four to six days necessary after an open chest operation.

Our thoracic surgeons work closely with other University of Chicago cancer experts to provide the full range of treatment options for lung cancer. »Learn more about our lung cancer care services

Pleural Effusion

Pleural effusion is the presence of excess fluid in the pleural space, the space between the lungs and the chest wall. VATS surgery may be performed to remedy this problem by removing restricting tissue around the lung, applying medicine to reduce fluid accumulation, or inserting a temporary drainage tube, substantially reducing symptoms associated with the fluid collection.

Pneumothorax

Pneumothorax occurs when air leaks into the space between the lungs and chest wall, causing part or all of a lung to collapse. VATS surgery is typically performed to prevent recurrence of the problem, or when prior treatment with a chest tube is unsuccessful. Any abnormal blisters on the surface of the lung that contribute to air leakage are removed, and medicine is applied to the pleural surfaces to reduce the risk of future lung collapse.

Esophageal Cancer

Patients who have esophageal cancer and cancer of the junction between the esophagus and stomach are often candidates for resection of the esophagus. Our team performs resections in most patients using a minimally invasive approach for both the abdominal and the thoracic portions of the operation. Usually, patients who have these operations have undergone preoperative chemotherapy or chemotherapy combined with radiation therapy. This technique may reduce the risk of complications after surgery, shorten hospital stay, and provide equivalent long-term benefits for cancer survival.

Mediastinal Tumors

Mediastinal tumors are tumors that develop in the mediastinum -- the area of the chest that separates the lungs and contains the heart, aorta, esophagus and trachea. These tumors can be seen in the front (anterior), middle, or back (posterior) of the mediastinum. They form and grow in the thymic (thymoma), nerve (neural), lymphatic (lymphoma) or soft tissue. Although open surgery is sometimes necessary, our thoracic surgeons use VATS or robotic techniques to remove mediastinal tumors whenever possible. »Learn more about mediastinal tumors

Thymectomy for myasthenia gravis: Thymomas (mediastinal tumors seen in the thymus) are sometimes found in people diagnosed with myasthenia gravis. Thymectomy, or surgical removal of the thymus, is sometimes appropriate for patients with myasthenia gravis, even when no tumor is present, as a means of improving their neurologic symptoms. At the University of Chicago Medicine, thymectomy often can be performed through one or more small incisions such as transcervical (small neck incision) or with a VATS or robotic approach, rather than using a long chest incision.

Other Conditions

In addition to the conditions listed above, University of Chicago thoracic surgeons perform minimally invasive surgery for the following conditions:

• Achalasia, a disorder of the esophagus that makes it difficult to swallow food.
• Barrett's esophagus, a precancerous condition that develops as a result of gastroesphageal reflux disease.
• Gastroesophageal reflux disease (GERD), a condition when a higher-than-normal amount of gastric juice refluxes from the stomach back into the esophagus.
• Hyperhidrosis, or excessive sweating. Using endoscopic techniques, our surgeons can destroy or remove the sympathetic nerve, which greatly reduces symptoms.