What is Robot Assisted Thoracic Surgery

Robot assisted thoracic surgery is a procedure in which robotic arms and surgical instruments are used to perform complex procedures through small incisions. During surgery, the surgeon sits at a console in the operating room and uses controls at the console to move the robotic arms.

Surgical instruments are attached to the ends of the robotic arms. Instruments include a tool with a light and camera on the end of it (thoracoscope). The camera sends images to a video monitor that your surgeon will use to view the inside of your thoracic area. The thoracic area is between the neck and abdomen.

Robot-assisted surgery may be done to:

• Remove a tissue sample to be tested in a lab (biopsy).
• Remove a part of a lung (lobectomy) or the whole lung (pneumonectomy).
• Remove tumors.
• Treat other conditions that affect:
  • Your esophagus. This is the part of your body that carries food and liquid from your mouth to your stomach.
  • Your diaphragm. This is a muscle wall between your lungs and stomach area. It helps with breathing.
• Remove a portion of the nerves (sympathectomy) that cause excessive sweating.

Tell a health care provider about:

• Any allergies you have. This is especially important if you have allergies to medicines or sedatives.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection, such as pneumonia.
• Severe bleeding (hemorrhage).
• Allergic reactions to medicines.
• Damage to organs or structures such as nerves or blood vessels.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• Before you go into the operating room, you may be given antibiotic medicine to help prevent infection.
• Talk with your health care provider about safe and effective ways to manage pain before and after your procedure. Pain management should fit your specific health needs.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may have tests, such as:
  • CT scan.
  • Ultrasound.
  • Chest X-ray.
  • Electrocardiogram (ECG).
• You may have a blood or urine sample taken.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• One to four small incisions will be made. The number of incisions and the area where incisions are made will depend on the purpose of your procedure.
• Necessary procedures will be performed using the robotic system.
• A drainage tube may be placed to drain excess fluid from the surgical area.
• Your incisions will be closed with stitches (sutures) or staples and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have a drainage tube in place. It may stay in place for a few days after the procedure to monitor for signs of air or fluid buildup in your lungs.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.

Summary

• Robot-assisted thoracic surgery is a procedure in which robotic arms and surgical instruments are used to help perform complex procedures through small incisions. During surgery, the surgeon sits at a console in the operating room and uses controls at the console to move the robotic arms.
• Compared to surgery between the neck and abdomen that is done by hand (traditional thoracic surgery), robot-assisted surgery allows the surgeon to perform complex procedures more easily.
• A drainage tube may be placed to drain excess fluid from the surgical area. The tube will be closely monitored for fluid or air buildup in your lungs.

Robot-Assisted Thoracic Surgery, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some pain and aches in the area of your surgical cuts (incisions).
• Pain when breathing in (inhaling) and coughing.
• Tiredness (fatigue).
• Trouble sleeping.
• Constipation.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Talk with your health care provider about safe and effective ways to manage pain after your procedure. Pain management should fit your specific health needs.
• Take prescription pain medicine before pain becomes severe. Relieving and controlling your pain will make breathing easier for you.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Avoid sitting for a long time without moving. Get up and move around one or more times every few hours.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. You may take showers.

Incision care

• Follow instructions from your health care provider about how to take care of your incision(s). Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Ask your health care provider when it is safe for you to drive.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions. These will vary depending on what procedure you had. Your health care provider may recommend:
  • A liquid diet or soft diet for the first few days.
  • Meals that are smaller and more frequent.
  • A diet of fruits, vegetables, whole grains, and low-fat proteins.
  • Limiting foods that are high in processed sugar and fat, including fried and sweet foods.

Pneumonia prevention

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Avoid secondhand smoke.
• Do deep breathing exercises and cough regularly as directed. This helps to clear mucus and prevent pneumonia. If it hurts to cough, try one of these methods to ease your pain when you cough:
  • Hold a pillow against your chest.
  • Place the palms of both hands over your incisions (use splinting).
• Use an incentive spirometer as directed. This device measures how much air your lungs are getting with each breath. Using this will improve your breathing.
• Do pulmonary rehabilitation as directed. This is a program that includes exercise, education, and support.

General instructions

• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• If you have a drainage tube:
  • Follow instructions from your health care provider about how to take care of it.
  • Do not travel by airplane after your tube is removed until your health care provider tells you it is safe.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have redness, swelling, or pain around an incision.
• You have fluid or blood coming from an incision.
• An incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.
• You have a fever.
• You cannot eat or drink without vomiting.
• Your prescription pain medicine is not controlling your pain.

Get help right away if:

• You have chest pain.
• Your heart is beating quickly.
• You have trouble breathing.
• You have trouble speaking.
• You are confused.
• You feel weak or dizzy, or you faint.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Talk with your health care provider about safe and effective ways to manage pain after your procedure. Pain management should fit your specific health needs.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do deep breathing exercises and cough regularly as directed. This helps to clear mucus and prevent pneumonia. If it hurts to cough, ease pain by holding a pillow against your chest or by placing the palms of both hands over your incisions (splinting).