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Thoracic surgeons at Monmouth offer patients advanced procedures,
including:
The da Vinci Surgical System provides a sophisticated
robotic platform designed to enable complex surgery using a minimally
invasive approach. Lourens
Willekes II
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.
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.
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.
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
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)
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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