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For hospitals doing thoracic surgery, the question of investing extensively in a minimally-invasive thoracic surgery program is not "Should we?" but "How quickly can we?"
Minimally-invasive thoracic surgery is fast becoming the norm for many of these procedures at leading institutions. Indeed, major medical centers and tertiary hospitals already are undertaking between 40% and 80% of thoracic cases using minimally invasive techniques. Minimally invasive thoracic procedures have become "a very common part of what we do," said Larry Kaiser, M.D., chair of thoracic surgery for the University of Pennsylvania in Philadelphia and a pioneer in the field of thoracic minimally invasive surgery (MIS). The University of Pennsylvania has had a thoracic MIS program since 1991.
Surgeons more comfortable with minimally invasive technology
Recent growth in the use of minimally invasive techniques, however, is due to major improvements in optics for video thorascopes, better instrumentation and improved anesthesia. Since the early 1990s, when only a few fledgling programs existed at leading institutions, programs have multiplied. Additionally, advances in imaging technology, particularly spiral CT scans, have proved a major boon, allowing physicians to identify lung nodules the size of a dime.
Correspondingly, the number of thoracic MIS procedures has risen each year over the years as many surgeons performing them became convinced that doing MIS procedures doesn't compromise patient outcomes. Thoracic surgeons have grown more comfortable using the technology. Until recently, surgeons put their hands inside patients' chest cavities to feel for tumors, making the paradigm shift to thoracic MIS nothing short of remarkable.
Minimally invasive thoracic surgical applications
Currently, thoracic MIS is primarily used for biopsies, lung wedge resections, pleural procedures and, increasingly, lobectomies (partial lung removal) and for lung volume reduction surgery (LVRS). In general, minimally invasive surgeries for lung cancer make sense for smaller tumors that don't show signs of spreading, Kaiser said.
A number of disorders affecting the esophagus can and are also performed using minimally invasive techniques, avoiding large thoractotomies and using smaller incisions. Two common benign conditions treated using MIS are achalasia and esophageal diverticulum. Tumors of the esophagus, both benign and malignant, can also be surgically treated using MIS. The entire esophagus can be removed using MIS for cancer patients. Gastroesophageal reflux disease (GERD) that cannot be adequately managed...