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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. |
