Advances in technology have made the early detection of lung cancer a reality for thousands of individuals at risk. If caught at its earliest stages, this deadly disease can frequently be cured. Alone or in combination with other cancer therapies, surgery offers the best chance of stopping the cancer from growing and spreading.
At NorthShore, our dedicated thoracic surgeons have extensive experience performing lung resection surgery for lung cancer as well as non-cancerous conditions. As specially-trained lung surgeons, they are renowned for their expertise in providing minimally invasive video assisted thoracoscopic surgery and have one of the largest experience in the region with advanced robotic techniques. Robotic assisted lung surgery involves the use of a small camera (thoracoscope) to gain an up close, 3-dimensional view of the lungs and thin endoscopic tools with advanced wristed motion for removing the diseased tissue. These surgical instruments are inserted into the chest area via small incisions made between the ribs. Unlike traditional open surgery (thoracotomy), robotic assisted surgery is done without the need for large incisions or painful rib spreading. This advanced technique offers:
- less pain
- quicker recovery
- smaller incisions and less scarring
- fewer chances of infection
More than 95 percent of early-stage lung resections at NorthShore are performed using a minimally invasive approach compared with the national average that is significantly lower.
Different Types of Lung Surgeries
Depending on your tumor’s location and size, your NorthShore surgeon will recommend one of several procedures to remove the abnormal growth. These surgical approaches vary based on the amount of tissue that can be safely removed and still provide viable lung function and quality of life. They include:
- Lobectomy: The most common operation for lung cancer, especially for tumors larger than 2 cm (around 1 inch). This procedure involves removing the entire lobe of the lung that contains the cancerous nodule. The amount of tissue removed represents about 15-20 percent of the overall lung volume and is about the size of your fist.
- Wedge Resections: For very small tumors or if patients are not good candidates for lobectomy, this procedure is used to cut out the nodule and a much smaller amount of normal lung tissue around the nodule. The amount of tissue removed represents less than 5 percent of the overall lung volume and is typically the size of your thumb.
- Segmentectomy: This surgical approach is also used for small tumors (less than 2 cm) that can’t easily be taken out via wedge resection due to their location on the lung or for patients who have poor lung function at baseline and are not a candidate for a lobectomy. Typically the amount of tissue removed represents about 10 percent of the overall lung volume and is about the size of half a fist. Segmentectomy is slowly replacing lobectomy as the standard of care for small cancer. NorthShore surgeons have been performing segmentectomy for years, and are leaders in using robotic assisted surgery to perform very complex, lung sparing segmental resections.
- Pneumonectomy: The removal of an entire lung, pneumonectomy is usually reserved for advanced cases of lung cancer. While typically performed with open surgery, depending on the tumor location, robotic surgery can sometimes be performed. While uncommon overall, NorthShore Surgeons are regional leaders in using minimally invasive robotic surgery even in cases that require a pneumonectomy.
Preparing for Lung Resection Surgery
You may need to be seen by your primary care physician prior to undergoing lung resection surgery. Your pre-operative clearance will include a discussion of your medical history and a physical exam. You may also be required to undergo several diagnostic tests, including:
- Blood Workup
- PET Scan
- PFT/Lung Function Test
What to Expect
All lung surgeries (minimally invasive and open) are performed under general anesthesia. Robotic assisted surgery, also called thoracoscopy, involves several small incisions made under the arm and between the ribs. The incisions range in size from about ½ an inch to 1 inch. Open surgery (thoracotomy) typically requires a large incision on the side of your chest and gentle rib spreading to allow access to your lung and chest cavity.
The length of stay in the hospital varies, depending on your procedure:
- Minimally invasive thoracoscopic wedge resections: 1 to 2 days on average
- Robotic segmentectomy or lobectomy: 2 to 3 days on average
- Open lobectomy or pneumonectomy: 3 to 4 days on average
After the procedure, your pain will be controlled using one of several methods: multiple non-narcotic pain medications taken orally and given on a schedule, stronger oral pain medication that you request from a nurse, and intravenous pain medication given, by a nurse administering medicine through your intravenous line at your request. At the time of surgery, a long-acting anesthetic medication is placed directly into the space between your ribs by the surgeon. This pain-control method has been proven to significantly reduce post-operative pain.
After your discharge from the hospital, you will want to make arrangements to have someone with you for the first couple of days if you live alone. You will not be able to drive until you are off of pain medicines. Some patients may require oxygen at home for a short time, typically 4 to 6 weeks.
For More Information
To schedule an appointment with one of our thoracic surgeons, please call 847.570.2868.