With tiny incisions, video cameras, surgeons pioneer chest procedures that are less painful, faster to heal, studies show


When he started out as a thoracic surgeon three decades ago, Robert McKenna Jr., MD, tackled lung surgery the traditional way: He opened chests — leaving patients often with long recoveries.

"I thought, it's crazy to keep making that big incision to do lung surgery," he recalled. "When we can do the same operation through smaller incisions, patients hurt less."

And so McKenna, medical director of Thoracic Surgery and Trauma at Cedars-Sinai and co-director of the Women's Guild Lung Institute, pioneered a minimally invasive technique that lets surgeons peer inside the lungs without needing to open the chest.

In video-assisted thoracoscopic surgery, or VATS, surgeons operate with the aid of tiny video cameras inserted through 1 ½-inch incisions, avoiding eight-inch cuts required in the traditional approach. Images displayed on overhead computer monitors provide close-up views of the lungs and other organs, allowing surgeons to maneuver while reducing trauma to the body.

Since introducing the method in 1992, McKenna and other Cedars-Sinai surgeons have performed the minimally invasive surgery on more than 3,500 patients with lung cancer, emphysema and disorders of the esophagus and chest wall — more than any medical center in the world.

McKenna said the technique improves postoperative pulmonary function and enables patients to walk out of the hospital in a matter of days rather than weeks. He recalled one patient who underwent lung surgery on a Monday, left the hospital the next day, drove home to Montana and went skiing that weekend. Not all patients spring back that quickly, but McKenna said the case underscored the benefits of the video-assisted surgery.

"The recovery is faster," he said. "It makes it much easier for patients to have the operation."

This technique doesn't compromise cancer treatment. Several studies have found no difference in survival rates for patients who undergo minimally invasive versus traditional open-chest procedures. The same studies have shown that the minimally invasive technique offers distinct advantages, including lower infection rates and less bleeding and postoperative pain. Surgeons from around the world visit Cedars-Sinai to learn from McKenna and his colleagues, all leaders in the field.

Among Cedars-Sinai's experts is Harmik J. Soukiasian, MD, associate director of Thoracic Surgery who uses his VATS-method expertise to treat lung cancer and benign thoracic disease. He also specializes in minimally invasive esophageal surgery, including minimally invasive esophagectomies.

He has written extensively about esophageal diseases and their surgical approaches. His research focuses on surgical and medical interventions to help cure esophageal cancer, reflux and Barrett's esophagus, a disorder in which the lining of the esophagus is damaged by stomach acid.

"People are selecting minimally invasive procedures because they have a better recovery while not compromising cancer care," Soukiasian said. "If we are able to offer this advanced video-assisted technique, it's certainly an advantage for the patient receiving the operation."

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