The Department of Thoracic Surgery

About our Advanced Procedures

Thoracic surgeons at Monmouth offer patients advanced procedures, including:

Robotic Surgery

The da Vinci Surgical System provides a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. Monmouth Medical Center was the first hospital in the region to introduce robotic surgery, and the hospital's assistant program director for the Department of Surgery, Lourens Willekes II, M.D., is one of a select group of thoracic surgeons in New Jersey trained in robotic surgery.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits. Complex procedures like thoracic surgery require an excellent view of the operative field and the ability to maneuver instruments within the chest cavity, and while smaller incisions have been used to perform a variety of thoracic procedures, many surgeons feel the reduced access of traditional laparoscopic surgery may limit visualization and may impede access to the operative field. In contrast, the da Vinci System's unique EndoWrist Instruments and InSite Vision System provides better control, dexterity and visualization than with an open procedure — allowing Dr. Willekes to offer his patients the benefits of minimally invasive surgery, including less scarring, pain, blood loss and infection risk, a shorter hospital stay, reduced recovery time and better clinical results.

For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.

 

Video Assisted Lung and Chest Surgery (VATS)

Recently, a less invasive procedure for treating early stage lung cancer has been developed. This is called video-assisted thoracic surgery. A tiny video camera can be placed through a small hole in the chest to help the surgeon see the tumor. Only small incisions are needed, so there is a little less pain after the surgery. Most experts recommend that only tumors smaller than 4 to 5 cm (about 2 inches) be treated this way. The cure rate after this surgery seems to be the same as with older techniques. It is important, though, that the surgeon performing this procedure be experienced since it requires more technical skill than the standard surgery.

Each year, more than a million thoracic (chest) surgical procedures are performed in the United States for heart and lung disease, muscle and nerve disorders, ulcers and other serious illnesses.

Although surgery may be the best, or only way to treat the disease, patients can sometimes face a long and difficult recovery because traditional "open" thoracic surgery is highly invasive. In most cases, surgeons must make a long incision through chest muscles and then cut or spread the patient's ribs to reach the diseased area. As a result, patients may spend up to a week in the hospital and face up to four to six weeks of recovery at home.

Now, a surgical technique known as video assisted thoracic surgery (VATS) is enabling surgeons to perform many common thoracic procedures in a minimally invasive manner. Depending on the type of procedure, most patients do not need intensive care, can leave the hospital in 1 to 3 days and, in many cases, are back to normal activities within a week.

What is video assisted thoracic surgery?
In most VATS procedures, surgeons operate through two to four tiny openings between the ribs while viewing the patient's internal organs on a television monitor. Each opening is less that one inch in diameter, whereas 6- to 10-inch incisions are not uncommon in open thoracic surgery.

What diseases can be treated with VATS?
Because it can offer patients significant advantages over open surgery, many surgeons believe that VATS will one day be used in the majority of all thoracic procedures. While not every patient is a candidate for video assisted thoracic surgery, VATS has been used at Monmouth Medical Center to:

  • Treat blebs on the lung (which can lead to a collapsed lung)
  • Diagnose and treat fluid around the lung
  • Diagnose and treat mediastinal tumors (tumors in the area between the lungs)
  • Diagnose, or stage, lung cancer
  • Treat lung cancer in patients who cannot tolerate open surgery
  • Reduce lung volume in emphysema patients

Can other diseases be treated with VATS?
In addition to lung procedures, VATS also has been used to treat:

  • Myasthenia gravis (a disease often resulting in weakened muscles and fatigue sometimes associated with tymus gland tumors)
  • Esophageal achalasia (a thickening of the muscle in the esophagus, which causes difficulty in swallowing)

Am I a candidate for VATS?
Although there are many benefits associated with VATS, it may not be appropriate for some patients, including those who have had previous thoracic surgery or who have some pre-existing medical conditions. Only a thorough medical evaluation by your personal physician, in consultation with a qualified thoracic surgeon can determine if video assisted thoracic surgery is appropriate for you.

How is VATS performed?
It is important to remember that neither VATS nor open thoracic surgery describes a specific surgical procedure. Instead, they describe the techniques a surgeon uses to gain access into the chest cavity or "thorax".

However, all VATS procedures generally start the same way. Patients are placed under general anesthesia and are typically positioned on their sides. Using a trocar (a narrow tube-like instrument), the surgeon gains access into the chest cavity through a space between the ribs. An endoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient's internal organs on a television monitor.

One of the most common VATS procedures is for preventing or repairing a collapsed lung. Called a video assisted blebectomy, the procedure involves removing diseased tissue, known as a bleb, which is like a blister on the lung. If the bleb ruptures, it forms a hole, and the lung begins to deflate or collapse.

To remove the bleb, the surgeon inserts three trocars: one for the endoscope and two for special instrumentation. After locating the bleb, the surgeon removes the diseased tissue and seals off the healthy portion of the lung.

Following the procedure, the small incisions are closed with surgical tape or a stitch or two. In most cases, the incisions are barely visible after a few months.

What are the advantages of VATS?
Because surgeons operate through 2 to 4 tiny openings instead of a long incision, many VATS patients experience less pain, less scarring a shorter hospital stay and, in many cases, a quicker return to work and other normal activities than patients who undergo open surgery. In addition, because it is not necessary to spread or cut the ribs, patients avoid some of the "bone pain" associated with the open approach.

How long will I be in the hospital?
Most VATS patients are out of the hospital in 1 to 3 days, and less than 10% require intensive care. In comparison, most patients who undergo traditional procedures spend 5 to 7 days in the hospital.

When can I go back to work?
Some patients return to work and other normal activities in as little as a week after video assisted procedures. This compares with 4 to 6 weeks for patients who have open surgery. However, you should consult your doctor before returning to work or resuming other activities.

Should I be concerned that VATS is a new technique?
Minimally invasive surgical techniques have been used in gynecologic surgery for nearly 3 decades, and today, more than 90% of all gallbladder surgery is performed using these techniques. Most recently, surgeons have applied minimally invasive techniques to a broad range of procedures including hernia repair, appendectomy, hysterectomy, heartburn surgery and bowel surgery.

However, before undergoing any type of surgery, whether minimally invasive or open, you should ask your surgeon about his or her training and experience.

What can I expect after surgery?
After surgery, it is important to follow your doctor's instructions. If you are like most people who undergo a minimally invasive procedure, you will probably feel better in just a few days. However, it is important to remember that although you may feel great, your internal organs still need time to heal.

 

Conditions Treated

Barretts Esophagus
The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Barrett's esophagus is a condition that causes a precancerous change to the thin layer of tissue lining the esophagus.

Gastroesophageal Reflux Disease (GERD)
The term gastroesophageal reflux describes the movement (or reflux) of stomach contents back up into the esophagus, the muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Because the stomach manufactures acid as an aid to digestion, this phenomenon is often referred to as acid reflux.

Achalasia and Esophageal Motility Disorders
When a person swallows, the coordinated muscular contractions of the esophagus propel the food or fluid from the throat to the stomach. Achalasia is a rare swallowing disorder that affects only 1 in every 100,000 people. Patients typically first note increasing difficulty swallowing. Most people are diagnosed between the ages of 25 and 60 years. It is usually a chronic condition that worsens over time and does not resolve.

Esophageal Cancer
The esophagus is a muscular tube that carries food and liquid from the mouth to the stomach. The esophagus is usually between 10 and 13 inches long. The normal adult esophagus is roughly three fourths of an inch across at its smallest point. The wall of the esophagus has several layers. Cancer of the esophagus — also referred to as esophageal cancer — starts from its inner layer and grows outward.

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The Department of Thoracic Surgery

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