As a result, patients leave the hospital in half the time of conventional lung surgery, and they can usually return to work in only two weeks.

With a traditional thoracotomy, patients remain in the hospital as long as a week after surgery.

“It’s a way of treating cancer with a less invasive procedure that will get patients back to their regular activities sooner,” says Allan Pickens, M.D., a thoracic surgeon at the University of Michigan Comprehensive Cancer Center and lecturer in surgery at the U-M Medical School.

Dr. Pickens recently completed fellowship training to learn the new technique and has performed about 20 of the procedures, called thoracoscopic lobectomies, since joining the U-M staff in January. U-M is one of a handful of centers nationwide that offers the surgery.

Four Small Incisions

Traditional lung cancer surgery is a thoracotomy, in which the surgeon cuts through the muscles into the chest and spreads open the ribs to access the lungs. The incision is large -- about 20 centimeters -- and recovery is slow and painful.

With the new technique, thoracoscopic lobectomy, the surgeon makes three small incisions of 2 centimeters to 4 centimeters each. A camera is inserted through a fourth incision that is only half a centimeter long. The camera allows the surgeon to see inside the chest. Very little muscle is cut and the ribs do not need to be spread.

“Thoracotomy is one of the more painful operations surgeons perform. It cuts into the muscles in a dynamic part of the body, an area that moves a lot from breathing. This makes it harder to heal afterward,” Dr. Pickens says.

Surgeons are seeing better pulmonary function -- a measure of how well a person can take a deep breath -- in patients who have the minimally invasive procedure compared to thoracotomy patients. In addition to going home sooner, recovery is easier and requires fewer narcotic painkillers. Initial research suggests cancer survival rates are similar for both procedures.

“This is the way thoracic surgery is moving toward for lung cancer treatment. It’s a technology I think in my heart improves medical care,” says Dr. Pickens.

Positive Results

Thoracoscopic lobectomy primarily is offered to patients with stage I or stage II disease, meaning the nodule is smaller than 5 centimeters, has not invaded the chest wall and has not spread to distant organs. More advanced cancer still will require traditional thoracotomy.

In lung cancer treated with thoracoscopic lobectomy, the entire lobe is removed, called a lobectomy. The same procedure may also be used to remove a portion of the lung, called a wedge resection.

In some cases, surgeons can perform a wedge resection to biopsy a nodule, and then proceed if it is cancerous to the full lobectomy at the same time. This may eliminate the need for needle biopsies or additional surgeries. Thoracoscopic lobectomy can be used for any disease of the chest or lung.

Results so far have been positive. Among the first 1,100 patients to receive this surgery, mortality rates were below 1 percent. The most common complication was air leaking through staple lines, a condition that typically resolves on its own.