Minimally invasive lung cancer surgery: Tiny incisions key to less pain and faster recovery
Dean Walker first attributed the pain between his shoulder blades to the herniated disc in his lower back. However, a magnetic resonance imaging test (MRI) revealed that the source of his pain was a tumor on his left lung. More tests determined shocking news: The tumor was malignant. Walker was scared: "The thought of having cancer was bad enough," he says. "But, the thought of having open chest surgery to cure it was just as terrifying. Especially the idea of getting my rib cage cracked open. That added to the anxiety ten-fold."
One of Walker's fears was eased when he met Virtua thoracic surgeon
Christopher Derivaux, MD, who told him he wouldn't need open-chest surgery at all. "Open surgery involves slicing through major muscles from the spine to the chest, and spreading open the rib cage," says Dr. Derivaux. "The pain is often disabling for the patient and recovery takes up to two months. However, with the advent of newer, sophisticated techniques, this is no longer the approach of choice for lung cancer treatment."
A minimally invasive option
Today, surgeons can achieve the same results with minimally invasive surgery (MIS). Surgeons operate through a few tiny openings the size of buttonholes, visually aided by a remote camera and a TV screen. "For most patients, this is the best option for lung cancer surgery," says Dr. Derivaux. "In fact, at least 80% of lung surgeries performed at Virtua Health are minimally invasive."
For Walker, the news brought welcome relief. And he found the entire experience much less traumatic than he'd expected. "The surgery wasn't long," he says. "The incisions were small and healed quickly, and I had very little pain."
Dioscoro Villanueva, MD, Virtua thoracic surgeon, adds that reduced pain is one of the great advantages of these new techniques. "We can never eliminate pain completely," he says, "but it used to be the worst part of lung surgery for the patient. Now it's dramatically reduced."
The minimally invasive approach for lung cancer treatment is called video-assisted thoracoscopic surgery (VATS). A scope with a camera attached is inserted into a tiny incision between the ribs. The camera projects a clear image of the lungs onto a TV screen. This image helps guide the doctor's hand throughout the surgery. In most cases, surgeons operate through three or four additional, centimeter-wide incisions. At least two are for the instruments, and one is for the removal of the lung section. "Each lung is made up of lobes," explains Dr. Villanueva. "Video-assisted surgery allows for the removal of nodules, or small masses, from the lobes; wedge resections in which only part of a lobe is removed; complete removal of lobes; or the removal of an entire lung."
Less pain and faster recovery
The surgery usually takes one to three hours, and the patient can go home in about four days. "This type of surgery offers many advantages," says Dr. Derivaux. "With less pain, patients require fewer pain medications. The incisions are much smaller and heal faster. And, overall, there's a shorter recovery as compared to open surgery. Most patients can get back to their normal lives in three to four weeks."
Both doctors point out that lung cancer treatment has come a long way. It was just over a decade ago that minimally invasive surgery was introduced into mainstream use for thoracic procedures. Today, thousands of minimally invasive lung surgeries are performed annually in the United States.
Still, many factors are considered before a patient is deemed a good candidate for this type of surgery. "Every case is unique," says Dr. Villanueva. "We look at anatomy, weight, overall health and other factors. Ideal candidates have had no prior lung surgeries and have small tumors less than three centimeters in diameter. These tumors also must be located in a peripheral location accessible from the surface of the chest."
Dean Walker feels fortunate to have met those requirements. He had caught the tumor in stage one, the earliest stage of growth. Today, he is happy to be back to his routine, playing golf, swimming and biking with his wife, Jan, and 12-year-old daughter, Arianna. "I feel very grateful every day," he says. "I've been given a second chance at life."