VATS / robotic lobectomy
A lobe of lung is removed through small ports using a camera, usually to cure early lung cancer.
Why it's done
- Early-stage non-small cell lung cancer (stage I–II and selected stage III). Anatomical lobectomy with lymph node dissection is the standard curative operation for fit patients.
- Fitness is checked with lung function (FEV1 and DLCO, with predicted postoperative values), cardiac risk and performance status. Borderline patients get exercise testing.
The steps
- One-lung ventilation: A double-lumen tube lets the anaesthetist deflate the lung being operated on.
- Position and ports: The patient lies on their side. One to four small incisions are made (uniportal, multiport or robotic).
- Hilar dissection: The pulmonary vein, the arterial branches and the bronchus to the lobe are dissected out one by one.
- Staple and divide: Each structure is divided individually with staplers. This is what makes it an anatomical resection rather than a wedge.
- Remove and stage: The lobe goes into a bag and comes out through the largest port. Mediastinal lymph nodes are taken for staging.
- Leak test and drain: The stump is tested for air leaks under water and a chest drain is placed.
Risks
- Prolonged air leak (beyond about 5 days)
- Atrial fibrillation
- Pneumonia and sputum retention
- Bleeding (a pulmonary artery injury is the feared one)
- Rarely, bronchopleural fistula
Recovery
Early mobilisation and physio are key. The drain comes out once the leak stops and output is low, and most patients go home within a few days. There's usually less pain than with an open thoracotomy.
St George's Cardiothoracic Surgery Society, City St George's, University of London.