Lung Volume Reduction Surgery using the da Vinci® Robotic Surgical System

Lung volume reduction surgery (LVRS) using the da Vinci Xi robotic surgical system is a minimally invasive surgical procedure performed to improve breathing when your lungs have been affected by severe emphysema, a type of chronic obstructive pulmonary disease (COPD) that causes shortness of breath and difficulty breathing. The procedure involves removing the section of the lung most damaged by the disease, allowing the remaining lung to function more effectively. The surgery enables patients to have less shortness of breath, improved ability to exercise, and a better quality of life.

Lung volume reduction surgery has traditionally been performed by making a large incision over the chest, cutting through bone and spreading the ribs apart to access the surgical site. With advances in technology, this surgery can now be performed through a few small incisions, about the size of your fingertip, in a minimally invasive manner using the da Vinci robotic surgical system with greater precision and control.

Working Mechanism of the Da Vinci Robotic Surgical System

The da Vinci surgical system consists of a surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system (3D camera), and miniaturized surgical instruments.

While performing the procedure, your surgeon will be seated at the da Vinci console to view a magnified, high-resolution, 3D image of the area to be operated on. A few small incisions (about 1 cm) are made in the space between the ribs to access the chest cavity without spreading or cutting the breastbone or ribs. The miniature instruments are introduced through the tiny incisions to access the surgical site, to help your surgeon perform the procedure with a high degree of precision. Master controls translate your surgeon’s hand movements into precisely controlled manipulations of the miniature instruments.

Indications

Lung volume reduction surgery using the da Vinci robotic surgical system is typically recommended for patients with severe emphysema/COPD who meet the following criteria:

• When all other medical treatments, such as medications and pulmonary rehabilitation, have been tried but symptoms still persist
• Have severe lung damage (emphysema), especially in the upper segment of the lung
• Have not smoked for at least 6 months
• Are not able to exercise well, even after completing pulmonary rehabilitation

Preparation

In general, lung volume reduction surgery using the da Vinci robotic surgical system will involve the following steps:

• A review of your medical history and an evaluation by a pulmonologist and thoracic surgeon
• A series of tests, such as pulmonary function tests (PFTs), cardiopulmonary exercise testing, arterial blood gas, a six-minute-walk test, electrocardiography (ECG), CT scans of the lungs, and an echocardiogram
• Informing your doctor about medications or supplements you are taking
• Informing the medical staff about any allergies to medications, anesthesia, or latex (which can be found in surgical gloves)
• Disclosing any recent illnesses or other medical conditions, which may impact the surgery
• Refraining from some medications, such as blood thinners and supplements, if contraindicated for the procedure
• Refraining from solids or liquids at least 8 hours prior to surgery
• Arranging for someone to drive you home following surgery
• Signing an informed consent form

Surgical procedure

Minimally invasive lung volume reduction surgery using the da Vinci robotic surgical system is performed under general anesthesia, meaning you will be asleep throughout the procedure and placed on a breathing machine.

During the da Vinci robotic LVRS, your surgeon sits at the computer console and looks through the stereoscopic, high-definition (HD) monitor to view inside the patient, providing a detailed three-dimensional view of the surgical area. The tower, which is positioned directly over the patient during surgery, contains the robot's four arms - three that can hold a multitude of different surgical instruments, and a fourth that holds the system's 3D cameras. These arms are controlled by a computer that precisely replicates the movements of the operating surgeon. Using the master controls, your surgeon maneuvers the arms of the robotic device to make three small incisions on the right side of the chest, accessing the lungs and removing the diseased areas of the lung, referred to as blebs. This allows the remaining lung tissue to function better for optimal breathing. By removing the nonfunctional lung tissue, the diaphragm, chest wall, and rib cage are able to return to a more normal shape and work more efficiently. After the surgery is complete, a chest tube is placed through one of the incisions to drain any excess fluid or air. This tube will stay in place for several days and be removed before you return home.

Postoperative care

Following surgery, your post-operation time in the hospital will depend on your underlying health and any possible complications that may have occurred during surgery. Pulmonary rehabilitation (an exercise program) usually begins within 4 to 6 weeks after surgery and is a crucial part of your recovery. The exercise program consists of at least 16 sessions, each at least 2 hours, completed over a 6 to 10-week time frame to improve lung function. Instructions on incision site care and bathing will be provided to keep the wounds clean and dry. You will require pain management with medications and ice packs. You should refrain from strenuous and heavy lifting activities for a defined period. Follow-up appointments will be scheduled to monitor your progress.

Benefits

Some of the benefits of the da Vinci robotic surgical system over traditional open surgery include:

• Smaller incisions
• Greater precision
• Faster recovery
• Shorter hospital stay
• Minimal risk of infection or bleeding
• Quicker return to normal activities
• No cutting of the ribs or sternum (breastbone)
• Minimal blood loss and fewer transfusions
• Minimal muscle trauma or scarring

Risks and Complications

As with any surgery, there are risks and complications that could occur. These include:

• Bleeding
• Infection
• Pneumonia
• Tissue damage
• Air leaks from the lungs into the chest cavity
• Adverse reactions to anesthesia
• Blood clots or deep vein thrombosis (DVT)

Summary

Lung volume reduction surgery using the da Vinci robotic surgical system is a newer surgical approach that greatly enhances the surgeon's visualization of the operative field, affording a higher degree of precision and control as compared to the traditional "open" surgery approach. This state-of-the-art system allows your surgeon to precisely remove the diseased tissue within the lungs to treat severe emphysema, a progressive form of chronic obstructive pulmonary disease.