What you need to know about VATS Lobectomy Patients
What is a VATS Lobectomy?
The removal of the lobe of the lung using a camera, laparoscopic instruments, and two small incisions in the lower chest, and a small 4-5 cm incision in the upper chest laterally, just below the axilla. This type of procedure is also called, thoracoscopic, or minimally invasive surgery (MIS).
Who gets VATS Lobectomy surgery?
Patients with lung cancer, lung nodule, or lung infection
What is removed?
The lobe of the lung with the cancer, nodule, or infection, and the surrounding lymph nodes
How is a VATS Lobectomy performed?
Under general anesthesia, the lung is collapsed, and three incisions as described above are made in the chest and a camera is used for visualization. Specialized instruments, similar to laparoscopic instruments, are used to perform the surgery. The vessels and bronchus are divided with a stapling device. The lobe is removed from the upper 4-5cm incision.
What is ERATS?
An initiative that is called “Early Recovery after Thoracic Surgery” (ERATS) and has been shown to improve recovery time, quicken return to daily activities, and a decreased need for opiates. This has been implemented here and is outlined below.
The ERATS Post Operative pathway
Length of Stay:
This largely depends on the timing of removal of chest tube, but is usually 4-5 days
Activity:
Compared to thoracotomy patients, activity is accelerated and recovery is quicker. Patients can ambulate the morning after surgery, and POD 1 should ambulate three times minimum, and 4-6 times each day thereafter.
Medications:
Research supports the use of the combination – scheduled Tylenol, Gabapentin, and Ibuprofen, and PRN Tramadol. If additional pain medication is needed, then oral oxycodone, or IV dilaudid are used.
Chest tube management:
The management is similar to post thoracotomy. Chest tubes initially are to suction, then changed to water seal.
Patient on suction: ambulate on the portable suction device.
Patient on water seal: ambulate without suction
Discharge with a chest tube:
Patients may be discharge with a chest tube in place. Exchange to a Mini-Atrium is required, and demonstration of this can be seen under “Mini-Atrium – Conversion from Pleurevac” section