In the past, chest surgery required a large incision and a week-long hospital stay. VATS offers another option, a “minimally invasive” TECHNIQUE. It allows surgeons to view the inside of the chest cavity using a thin scope and small incisions. VATS is used most often to:
- Find the cause of lung problems
- Drain fluid from around the lung
- Remove or biopsy chest tumors
- Help prevent build-up of fluid in the chest (Pleurodesis)
After VATS, patients have:
- A faster recovery
- Shorter hospital stay
- Less pain
With VATS, the risk for bleeding and infection are low. You will have a drainage tube from your chest after surgery that is removed before you go home. Sometimes, the tube has to stay in longer than one day, which may increase your hospital stay.
Please tell your doctor or nurse about your routine medicines and any allergies. One week prior to your surgery do not take any medicine containing aspirin. If you are unsure about which medicines are included in this group, ask your doctor, nurse or pharmacist. Acetaminophen (Tylenol) can be taken for minor pain, unless instructed otherwise.
The night before your surgery, do not eat or drink after midnight. As instructed, take needed medicines with small sips of water. It is a good idea to shower the night before surgery. All nail polish should be removed.
VATS is done in an operating room (OR) under general anesthesia. You are not aware of the surgery or your surroundings. A breathing tube may be placed in to your windpipe to help you breathe during surgery. A very small incision is made, usually between your 7th and 8th ribs. A tiny camera on a tube, called a “thorascope”, is then inserted through the opening. One or two other small incisions are made to perform the surgery itself.
At the end of your surgery, the small incision will be stitched closed with absorbable suture. These sutures do not have to be removed. A chest tube is left in, in one or more of the incisions until air and fluid drainage stop. A stitch is used to hold the tube in place. This stitch remains after the tube is removed and will be taken out in the clinic.
Once in the recovery room, a chest x-ray is taken. Pain medicine is given to keep you comfortable.
From the recovery room, you will go to the CVU (Cardiovascular Unit) located on the 3rd floor. You will have oxygen and an IV (into the vein) line for needed fluids and medicines.
After surgery, you will begin with a clear liquid diet. If you have any stomach upset, please tell the nurse. Most patients are out of bed the day of surgery and walking in the hallways that day or the next. It is important to walk in the hall 4-5 times per day.
The nurse will:
- Help you cough and deep breathe
- Show you how to use an incentive spirometer
Use the incentive spirometer 10 times every hour while awake to assist you with deep breathing. This helps clear your lungs and prevent pneumonia.
It may hurt to cough and take deep breaths. Medicine is given to relieve soreness and incision pain. Be sure to tell the nurse how the medicine is working. Rate your pain on a scale of 0-10 with 0 meaning no pain and 10 the worst pain you could imagine. Take pain medicine at regular times, as needed. Good pain control along with deep breathing and walking help speed your recovery.
For some VATS procedures, patients may go home the same day. Most patients go home 1 to 3 days after surgery, when they are up and about and medicine (by mouth) controls their pain. Before you go home, your IV and chest tubes are removed. The nurse will review your home care guidelines with you and answer any questions. A prescription for pain medicine may also be given.
Some pain is expected after surgery, but it should lessen each day. Your pain should be controlled by your pain medicine. Contact the office for any severe pain not controlled by your medicine.
There are no diet restrictions. Resume your regular diet.
Continue to do coughing and deep breathing exercises. Gradually increase your activity each day. Please take your pain medicine as directed and increase activity as much as possible. Remember that activity reduces your risk for pneumonia. Most patients find they are back to their usual routine within 2-3 weeks after surgery. Talk to your doctor about returning to work. This depends on your work and its demands. You may drive when you are no longer taking pain medicine and you feel you can react in an emergency. This is often 2 weeks after surgery and your follow up office visit. Talk with your doctor before you resume driving.
Wound Care and Bathing
Your incisions are sealed with a “glue”. You can get the incision wet when you shower. The dressing over the chest tube sites may be removed after two days. The suture under this dressing will be removed at your follow up visit in the office. You may shower 24 hours after surgery and then daily after that. Do not take a tub bath or go swimming until your wounds are completely healed, which is usually in 2-4 weeks. Avoid lotions, creams or powders near wounds to prevent infection and irritation of these areas.
If an appointment has not been made for you, call your doctor’s office for your follow up visit for 1-2 weeks after your surgery. Please call the clinic if you have any questions or concerns.
When to call the Doctor
Please call your doctor if you have:
- Temperature of 100.5oF or greater
- Increased swelling, redness or tenderness at wound sites
- Drainage from any of your wounds
- Shortness of breath
- Severe pain not controlled by medicine