Video-Assisted Thoracic Surgery
Daniel T. DeArmond, MD, Thoracic Surgery
Physician referrals and patient appointments: please call 210-358-4579 or 210-358-4026. For after hours,
weekends, or holiday referrals, please call 210-567-0001.
Minimally invasive techniques (i.e., VATS thoracoscopy) are routinely used to diagnose lung masses that are suspicious for cancer.
Prognosis after VATS lobectomy has been shown to be superior to prognosis after open lobectomy in early non-small-cell cancer, possibly because of the low level of invasiveness of the VATS lobectomy.
Dr. DeArmond is fellowship-trained in minimally invasive video-assisted thoracic surgery. During his fellowship training at Cedars-Sinai Medical Center, Los Angeles, CA, he performed approximately 100 VATS lobectomies or segmentectomies and assisted on another 50. After joining the Surgery faculty at the UT Health Science Center at San Antonio in August 2007, Dr. DeArmond performed the first ever VATS lobectomy at University Hospital, with impressive outcomes: operative time, including frozen section, was only three hours, and the patient was discharged on the second post-operative day.
New lung cancer procedure is less invasive:
A new surgical procedure for early-stage lung cancer is helping patients recover more quickly and
without as much pain as the traditional operation. Daniel DeArmond, MD, Cardiothoracic Surgery, is one of
only a very small number of thoracic surgeons in San Antonio who is performing the new video-assisted
thoracic surgery procedure (VATS).
View KENS-5 video |
SA Express-News article |
More about Dr. DeArmond
Video-assisted thorascopic surgery (VATS) procedures performed by Dr. DeArmond:
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When surgeons at Cedars-Sinai Medical Center developed the VATS lobectomy procedure in 1992, the hope was that minimally invasive surgery offered patients a shorter hospital stay, less risk, and quicker recovery, without compromising the completeness of the cancer operation.
Although it has been proven to be a safe and highly effective as a treatment option for lung cancer, video-assisted thorascopic surgery (VATS) lobectomy is still not widely practiced, in part due to a shortage of qualified, well-trained practitioners, which may be due to difficulties in acquiring the appropriate skills.
VATS lobectomy has distinct advantages over traditional surgery, including reduced morbidity, mortality and length of hospital stay, and an earlier return to regular activities for the patient.
What is VATS lobectomy? Very similar to a standard thoracotomy, VATS lobectomy is a standard lobectomy with smaller incisions. This procedure can be used for treatment of benign or malignant disease. The ribs are not spread or sectioned, allowing for a much faster recovery period for the patient. The VATS lobectomy procedure requires 4 incisions, usually none longer than 6cm.
The VATS lobectomy procedure can be used for most primary lung cancers, including adenocarcinoma, squamous cell, BAC, carcinoid, AD SQ, large cell, NSCL, small cell, sarcoma, and mucoepidermoid. Both the traditional thoracotomy and the VATS lobectomy provide complete dissection.
Dr. DeArmond participated in Cedars-Sinai Medical Centers 1992-2004 retrospective study of VATS lobectomy results. In a patient population of 1100, the patient mortality rate was .8 percent; 84% of the patients had no complications. The average length of stay for a VATS lobectomy is 3-5 days; average length of stay for a standard thoracotomy is 5-7 days.
Contraindications for VATS lobectomy include benign or malignant nodal disease, chest wall or mediastinal invasion, endobronchial tumor (central tumors), neoadjuvant chemotherapy or radiation therapy, or positive mediastinoscopy.
What are the benefits of the VATS lobectomy procedure? VATS lobectomy is a reasonable treatment option for lung cancer; complete nodal dissection is possible with this procedure. Benefits include a lower mortality rate than with a traditional thoracotomy, and the VATS procedure is more easily tolerated by older and/or poor performance patients. There is a lower risk of major bleeds, and a lower risk of seeding incisions. Indications of the efficacy and benefits of the VATS lobectomy procedure are constantly expanding, and there is a growing consensus that it is an effective treatment for lung cancer.
Intraoperatively, VATS appears to be as good as or better than a thoracotomy. Blood loss is significantly less with a VATS procedure; hospitalization time is shorter, intraoperative deaths and major complications are rare. Postoperative pain is generally less after a VATS procedure, and there is less postoperative impairment of pulmonary function.
