32669 Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)

Name of the Procedure:

Thoracoscopy, Surgical; with Removal of a Single Lung Segment (Segmentectomy)
Common Name(s): Thoracoscopic Segmentectomy, VATS Segmentectomy (Video-Assisted Thoracoscopic Surgery Segmentectomy)

Summary

Thoracoscopy with segmentectomy is a minimally invasive surgical procedure in which a small segment of the lung is removed. This is done using a thoracoscope—a thin, flexible tube with a camera and surgical instruments inserted through small incisions in the chest.

Purpose

This procedure is aimed at treating localized lung disease, such as small, early-stage lung cancers or benign lung tumors. The goal is to remove the diseased portion of the lung while preserving as much healthy lung tissue as possible.

Indications

• Early-stage lung cancer confined to a single segment of the lung.
• Benign tumors or growths in the lung.
• Removal of infected or damaged lung tissue in cases of repeated lung infections or diseases.
• Patient criteria: suitable lung function and overall health to undergo surgery.

Preparation

• Patients are commonly instructed to fast for 8-12 hours before the procedure.
• Pre-procedural tests may include chest scans (CT or MRI), blood tests, and pulmonary function tests.
• Medication adjustments might be necessary, particularly blood thinners or other medications that affect bleeding.

Procedure Description

1. The patient is given general anesthesia.
2. Small incisions are made in the chest to insert the thoracoscope and other surgical instruments.
3. The thoracoscope transmits images to a video monitor, guiding the surgeon to locate and remove the diseased lung segment.
4. The removed tissue is then retrieved through the incisions.
5. Incisions are closed with sutures or staples, and a chest tube may be placed to drain fluids.

Duration

Typically, the procedure lasts between 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Thoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technician

Risks and Complications

Common risks include infection, bleeding, and air leakage from the lung. Rare but serious complications could include prolonged air leaks, respiratory failure, or reactions to anesthesia. These risks are typically managed with post-operative care and monitoring.

Benefits

• Minimally invasive with smaller incisions, leading to reduced pain and faster recovery.
• Effective removal of localized lung disease while preserving as much healthy lung tissue as possible.
• Shorter hospital stay compared to traditional open surgery.

Recovery

• Post-surgery, patients may stay in the hospital for a few days for monitoring.
• Pain management includes prescribed painkillers and anti-inflammatory medication.
• Patients are advised to avoid strenuous activities for several weeks and attend follow-up appointments.
• Light activities and breathing exercises to improve lung function may be recommended.

Alternatives

• Traditional open surgery (thoracotomy): More invasive, longer recovery.
• Stereotactic body radiotherapy (SBRT): A non-surgical option, mainly for those unfit for surgery.
• Radiofrequency ablation: Minimally invasive, uses heat to destroy cancer cells but may not be as definitive as surgical removal.

Patient Experience

The patient will be under general anesthesia during the procedure and will not feel pain. Post-operatively, there may be some pain and discomfort around the incision sites, managed with medication. Patients can expect to gradually resume normal activities within a few weeks, but full recovery might take a few months.