Segmentectomy

The technique used in surgery depends on your body, the type of surgery and the tumor size and location.  Your surgeon will recommend the approach that is the safest for you and allows them to completely remove your tumor. The most common approaches are:

• Thoracotomy. This approach involves making an incision (opening) on the side and spreading open the ribs.

• VATS (video-assisted thoracoscopy surgery). This involves making multiple (three to four) smaller incisions where a camera and instruments are placed to do the surgery. The ribs are not spread in this approach, and it is generally less painful than a thoracotomy.  

• Robotic surgery. This approach is similar to VATS, in that multiple smaller incisions are made where a camera and instruments are placed to do the surgery. The ribs are not spread. With a robotic approach, the surgeon is at a console (away from the operating room table), controlling the instruments with the robot. In VATS, the surgeon is at the operating room table controlling the instruments directly. 

Thoracic surgery is generally safe. However, like any surgery, the procedure has a small risk of complications including:

• Wound infection.

• Prolonged air leak (needing your chest tube in longer than normal).

• Bleeding.

• Pain or numbness at the incision site.

• Infection such as pneumonia.

• Atrial fibrillation (irregular heartbeat that is usually temporary and controlled with medication).

• Ask any questions you may have about the procedure.

• Arrange to have any blood tests or other tests ordered by your doctor.

• If you smoke, stop right away. This decreases the risk of complications.

• Notify your doctor of all medications (prescribed or over-the-counter), vitamins and herbal supplements that you are taking, including aspirin. Your doctor may advise you to stop taking certain medications before your surgery.

• Do not eat or drink anything after midnight the night before your surgery, or as directed.

• Arrive at the hospital on time the day of your surgery.

It is highly recommended and extremely important to quit smoking immediately because it greatly increases your risk of heart and lung complications, including pneumonia, if you are smoking within a month before surgery. It can also cause problems with wound or incision healing.

• You will be directed to the perioperative area where you will change into a hospital gown. You will have to remove anything that may come off during surgery such as glasses, wigs, prostheses, jewelry, dentures, etc. A family member or friend can keep the items for you, or your nurse will store them for you in a secure area.

• A nurse will perform an assessment and complete the education process for your surgery.

• An anesthesiologist will see you and review the plan for anesthesia with you as outlined during your preoperative (pre-op) anesthesia consult.

• The surgery team will start on IV on you.

•  In rare cases, you may have a central line placed. This is an IV that is placed in the larger vein in the neck.  

• You may have an epidural catheter placed. This is a small catheter (tube) placed outside of the spinal cord in the back. This catheter is used to pump pain medication and numbing medication that will help control your pain after surgery. 

• An arterial line may be placed. This is a special line (similar to an IV) that is placed in the artery in your wrist and used to monitor blood pressure during your surgery.

• Up to two friends or family members may stay with you in the pre-op area until you are ready to be taken to the operating room.

• Friends and family will go to the surgery waiting room (also on the second floor of the hospital). The nurse in the operating room will keep them up to date. Your surgeon will also talk to them at the end of your surgery.

Day 1

• You will be in the intensive care unit.

• Blood will be drawn and your blood sugar levels will be monitored.

• Your chest tube may be changed from active suction (connected to a wall suction) to passive drainage, and drainage will be recorded.

  •  You will get a chest X-ray four hours after the chest tube is removed from suction.

• You may receive pain medication through an epidural or intrapleural catheter.

•  You will receive routine medications in addition to some of your home medications:

  • Heparin injections to prevent blood clots.

  • Metoprolol to prevent an irregular heart beat (atrial fibrillation).

  • Oral medication as part of the Enhanced Recovery Pathway.

• You will use your incentive spirometer 10 times every hour.

• You may be allowed to eat regular food.

• You will wear compression boots while in bed.

• You will get out of bed to a chair.

• You may transfer out of the Intensive Care Unit to a regular floor.

Day 2

• Your chest tube may be removed.

• Once your chest tube is removed, your epidural catheter may be removed.

• You will receive routine medications in addition to some of your home medications:

  • Heparin injections to prevent blood clots.

  • Metoprolol to prevent an irregular heart beat (atrial fibrillation).

  • Oral medication as part of the Enhanced Recovery Pathway.

• You will use your incentive spirometer 10 times every hour.

• You will wear compression boots while in bed.

• You will sit in a chair and walk around the room or hallway at least two to three times. 

Day 3

• Your chest tube may be removed if it is not already.

• Once your chest tube is removed, your epidural catheter will be removed.

• You will receive routine medications in addition to some of your home medications:

  • Heparin injections to prevent blood clots.

  • Metoprolol to prevent an irregular heart beat (atrial fibrillation).

  • Oral medication as part of the Enhanced Recovery Pathway.

• You will use your incentive spirometer 10 times every hour.

• You will wear compression boots while in bed.

• You will walk in the halls three times a day.

• You may be discharged today if your chest tube is out, your pain is controlled on oral medication and you are moving or walking on your own.