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VATS/RATS Lung Resection

What is a VATS/RATS Lung Resection?

A lung resection is the removal of a part or entire lobe of your lung. There are different ways that a lung resection surgery can be performed. These will be discussed below.

There are three different approaches that your surgeon can use to remove part of your lung: VATS, RATS, and thoracotomy. VATS stands for Video-Assisted Thoracoscopic Surgery. RATS stands for Robotic-Assisted Thoracoscopic Surgery. A thoracotomy is a larger incision made between the ribs, requiring rib spreading. A VATS and RATS approach are both considered to be minimally invasive with small incision sites made. Your surgeon will discuss with you which of the above approaches is best for you. This operation is done under a general anesthesia and typically takes between 2 to 4 hours. After you are asleep, you will be positioned on your side. During a VATS or RATS approach, your surgeon will make small incisions on the side of your chest that are about 1 to 4 cm in length. One of these incision sites is used for a camera to look around inside of your chest. The other incision sites are used for special instruments that are used to perform the operation. A special stapling device is used during the operation to remove lung tissue, divide blood vessels, and divide the bronchus (airway that is supplying your lung). Lymph node samples are typically removed during this procedure. The key element of VATS/RATS approach is to avoid spreading of the ribs.

At the end of the operation, the incision sites that were made will be closed using absorbable stitches that are underneath the skin. Typically, one or two of those incision sites will be used for a chest tube which drains any air or fluid that may still be in the chest after the operation. You will typically wake up with 1 to 2 chest tubes in place following the operation. Any lung tissue and lymph node samples that were removed during the operation will be sent to the laboratory for analysis, with results typically returned in about a week.

Your Operation: Surgical Approach


What are the Different Types of Lung Resections?

There are a few different types of lung resection procedures. Below we will discuss the differences between a wedge resection, lobectomy and segmentectomy.

Wedge Resection:

A wedge resection is a procedure that involves the surgical removal of a small, wedge-shaped piece of lung tissue. This can be used to remove or diagnose a small tumor or to diagnose different types of lung disease. This type of procedure is not ideal for treatment of lung cancer although it is sometimes preferred for patients who cannot tolerate the removal of a large section of lung when there may be a significant decrease in lung function. Your surgeon will discuss the reasons to undergo a wedge resection with you in detail prior to your procedure. 3.

Anatomic Lung Resection: Lobectomy and Segmentectomy:

Lobectomy: A lobectomy is a surgical procedure where an entire lobe of your lung is removed for a variety of reasons, but most commonly for treatment of lung cancer. There are three lobes that make up your right lung (right upper lobe, right middle lobe, right lower lobe) and two lobes that make up your left lung (left upper lobe, left lower lobe). During this type of lung resection, blood supply to the specific lung lobe that is being removed does need to be closed off. The bronchus is a tube-like structure that supplies air to your lungs. This structure also needs to be closed off prior to the removal of the lung lobe. The above is done using a special type of stapler that will securely divide these structures. 4

Segmentectomy: A segmentectomy is a lung resection that involves the removal of part of one of the lobes of the lung. As stated above, the right lung is divided into three lobes and the left lung is divided into two lobes. These lobes are subdivided into segments. This type of resection spares more lung tissue as compared to a lobectomy, therefore leaving a patient with higher lung reserve. In certain circumstances, you may be a candidate for a segmental lung resection. Your surgeon will have this discussion with you and decide which type of lung resection is right for you.

Understanding your Operation

If you are having a section of your lung removed, there are different approaches that your surgeon can do to remove part of your lung. The approach depends on the location and extent of your disease as well as your overall health.

Understanding your operation

Changes to Planned Surgery

There is always a risk that your surgery may not be able to be completed as planned. Sometimes the surgeon may be unable to do your operation using the VATS/RATS approach and therefore must extend one of the incision sites to make a longer cut to enable the completion of the operation; this is called a thoracotomy. Very rarely, if there is bleeding during the operation that cannot be controlled through the VATS/RATS incisions, the surgeon will need to make a longer cut to gain direct vision and control the bleeding. In addition, sometimes unexpected findings may change the plan for the surgery.

Preparation for Surgery

Most importantly, if you currently smoke, we strongly recommend that you stop at least three weeks prior to your scheduled procedure. Your risk of post-operative complications is drastically increased if you continue to smoke up until the day of your surgery. You will be asked to start a daily walking program prior to your surgery. This will be discussed in detail with you by your surgeon. You will most likely be required to have some testing completed prior to your lung resection surgery. Some of these tests include a breathing test (pulmonary function test), EKG (heart tracing), cardiac stress test, echocardiogram and blood work. You will not be able to have anything to eat starting at midnight the night before your operation. You can have clear liquids, such as water or black coffee, up until 2 hours prior to your procedure. You will be given a pamphlet with more details regarding this. If you take medications routinely at home, we will discuss which of these you can take before your operation and which you cannot. Prior to your surgery after you have been put to sleep, a catheter will be inserted into your bladder to monitor your urine output during and after the surgery. 6

After your Surgery

After your surgery has been completed, you will be taken to the recovery room. The nursing staff will monitor your vital signs (blood pressure, breathing rate, oxygen levels, heart rate) and make sure that you are comfortable. You will wake up with 1 to 2 chest tubes in place. You will remain in recovery for about 2 hours after your procedure and then you will be taken to your hospital room in the step down unit (2 south). You will be given supplemental oxygen to help you breath. You will also be receiving fluids through your IV. You will be able to drink and eat as soon as you can tolerate. The urinary catheter is typically removed the morning after surgery. The chest tubes will remain in place for at least 24 to 48 hours depending on the amount of drainage and if there are any air leaks present; this is determined by your surgeon. You will be getting many chest x-rays while you are in the hospital, so expect to be awoken early in the morning for this to be completed. You will be instructed on breathing exercises and deep coughing to prevent any chest infections. You will also be encouraged to walk in the hallway and exercise your legs to prevent any blood clots from forming. Walking is very important and you will be encouraged to get out of bed the same day as your surgery.

Pain Control: Following your procedure you should expect to have pain. We will control your pain with a multi-modal regimen including Tylenol, Gabapentin (helps nerve pain), and Celebrex (anti-inflammatory). You will also be given a narcotic pain medication as needed. We try to keep IV pain medication to a minimum, but each patient is different and pain medications will be adjusted as needed.

General Care: You will be expected to start walking either the night of surgery or the day following. The dressings over your chest tube site will be removed following removal of the chest tubes. The other incision site dressings will be removed in the office at your follow-up appointment. Once your chest tubes are removed, you are able to shower daily and are encouraged to do so. Patients are typically ready to be discharged home 2-4 days after their procedure.

Risks and Possible Complications

With any surgical procedure, there are certain risks associated and these risks will depend on your health before undergoing the operation. Your surgeon will discuss these risks with you in detail.

Sore throat: It is normal to have a sore throat following surgery. It is a result of being under anesthesia and having a breathing tube during the operation. This should get better shortly after surgery.

Changes in blood pressure/heart rate: Sometimes your blood pressure may be lower/higher after having anesthesia. This is normally due to not having anything to eat or drink prior to surgery and the medications you receive in the operating room. Your blood pressure may normalize once you begin having fluid intake. Your heart rate may be disrupted as well during the procedure. You will be given a medication, Metoprolol, in the hospital and at discharge to prevent any irregular heart rhythms or rates.

Coughing up blood (Hemoptysis): It is normal to cough up small amounts of blood tinged sputum (usually the size of a quarter) for the first few days after lung resection surgery. This will gradually reduce with time.

Chest infection/Pneumonia: Breathing exercises, walking, getting out of bed and adequate pain control will reduce the risk of a chest infection. Your chance of chest infection or pneumonia is 8 times more likely if you are a current smoker. If you do develop a chest infection, you may need treatment with an antibiotic and your hospital stay may be longer.

Air leaks: This is when the cut surface of the lung tissue leaks air. This typically resolves on its own in a few days however it does mean that your chest tubes will have to stay in place while it heals. Sometimes this means you will be sent home with a chest tube in place.

Pneumothorax: Occasionally the lung will not fully inflate following surgery and this may require having a chest tube in place for a longer duration. Sometimes this can occur after the chest tube is removed. In these instances, another chest tube may have to be placed to allow the lung to fully re-expand.

Heart attack or stroke: This can occur during or after any surgery. The risk is higher in patients with a cardiac history or undiagnosed cardiac disease. For this reason, every patient will have cardiac work-up completed prior to your procedure.


Your follow-up will be scheduled prior to you leaving the hospital. You will be seeing an advanced practice provider at your initial post-operative visit. You will be asked to get a chest x-ray completed at Medical Imaging of Fredericksburg prior to your appointment (that same day).


1. VATS Instruments: Diagram showing video assisted thoracoscopy.

2. RATS Set-up Picture: Robotic Approach to Lobectomy. Thoracic Key.

3. Wedge Resection Wedge Resection. Lung Cancer News Today.

4. Lobectomy Lobectomy. American Lung Cancer Association.

5. Wedge Resection/Lobectomy/Segmentectomy Lung Cancer. The Society of Thoracic Surgeons.

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