Programs and Services
Minimally Invasive and Robotic Thoracic Surgery
About 80 percent of thoracic surgeries performed at Froedtert & The Medical College of Wisconsin are done using a minimally invasive approach.
Minimally invasive thoracic surgery — also called thoracoscopy or thoracoscopic surgery — is performed with a thoracoscope, a thin, telescope-like instrument with a camera on the end that allows the surgeon to view inside the chest. With this type of surgery, small incisions are made in the chest or the abdomen. The thoracoscope and special surgical instruments are inserted through these incisions. Other names for this surgery include pleuroscopy or VATS (video-assisted thoracic surgery).
During traditional, open thoracic surgery, one long 6- to 8-inch incision is made in the chest. Minimally invasive thoracic surgery uses three to five very small incisions. As compared with traditional surgery, patients who undergo minimally invasive surgery typically experience less pain and scarring, a shorter hospital stay, a faster recovery, reduced risk of infection and less bleeding. Almost all traditional thoracic surgeries can be performed using a minimally invasive technique.
Minimally invasive thoracic surgery may be performed through the ribs or the abdomen:
- Through the ribs — the surgeon makes three small (about 1-inch) incisions. Procedures performed through the ribs include:
- Lobectomy to remove part(s) of the lung containing a cancerous tumor
- Esophagectomy to remove the esophagus as a treatment for cancer
- Thymectomy to remove the thymus gland as a treatment for myasthenia gravis
- Removing mediastinal masses (cysts or tumors in the chest cavity)
- Through the abdomen — the surgeon makes five small incisions in the abdomen; instruments are placed through the incisions and moved up to the chest region. These procedures include:
- Heller myotomy, in which muscles in the lower esophageal sphincter are cut to allow food and liquids to pass to the stomach. It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
- Repair of a paraesophageal hiatal hernia, in which part of the stomach is squeezed up into the chest beside the esophagus.
- Nissen fundoplication to treat gastroesophageal reflux disease (GERD), also called chronic heartburn, and hiatus hernia. During surgery, the valve between the stomach and esophagus is strengthened to prevent stomach acids from being forced back into the esophagus.
- Diaphragm plication to treat shortness of breath related to diaphragm paralysis.
Minimally invasive surgery will be considered first for any patient in need of thoracic surgery. Some procedures, however, are best performed using the traditional open technique.
Minimally Invasive Surgery With the da Vinci® Robotic Surgical System
|Trained thoracic surgeons at Froedtert & The Medical College of Wisconsin are using the da Vinci® Robotic Surgical System to perform many minimally invasive thoracic surgeries. The da Vinci system gives the surgeon improved magnification, precise robotic movements and a three-dimension view of the surgical site, delivering unmatched precision for performing complex and delicate thoracic procedures.
Learn more about the da Vinci Robotic Surgical System.
While all minimally invasive thoracic procedures can be done with the da Vinci® Robotic Surgical System, not all patients are candidates for robotic thoracic surgery. Some patients who require a lobectomy or an esophagectomy, for example, may not be suitable candidates for minimally invasive robotic surgery. The surgeon carefully evaluates each patient in need of thoracic surgery to determine the appropriate approach.
The da Vinci Surgical System is composed of four components: a surgeon console, a computerized control system, two instrument “arms” and a camera. During surgery, the surgeon views a three-dimensional image of the surgical site from the tiny camera placed inside the patient. At the console, the surgeon uses the robot’s arms to control the movement and placement of the surgical instruments. The robot’s “arm and wrist” movements mimic those of the surgeon, enhancing the precision of natural hand and wrist movements.
Medical College of Wisconsin thoracic surgeons who perform robotic thoracic surgery are:
- William B. Tisol, MD — Dr. Tisol is a proctor for the da Vinci Surgical System, teaching other thoracic surgeons how to perform robotic surgery. He is one of only four da Vinci proctors in Wisconsin and the only one teaching thoracic robotic surgery.
- Mario G. Gasparri, MD
- George Haasler, MD, FACS, FACCP
- Daryl Pearlstein, MD
In addition, physician assistant Melissa Dahnert is specially trained as a member of the robotic thoracic surgery team.
Author: Marla Fraunfelder
Date: April 15, 2009