Segmentectomy
Segmentectomy is a surgical procedure to remove a portion of the lung. It is performed to treat patients with lung cancer. At times, it is used to treat a benign lesion of the lung.
Operation
We use the most advanced robotic system called Da Vinci Xi to perform segmentectomy. The name of the procedure is “Robot-assisted thoracoscopic segmentectomy.” There are three lobes on the right and two lobes on the left and each lobe has a segment that can be removed. Depending on the location of the lesion, the procedure is a left ligulectomy, left upper trisegmentectomy, left lower superior segmentectomy, right lower superior segmentectomy, left lower basilar segmentectomy or right lower basilar segmentectomy. We perform the procedure through small incisions in the chest. We identify, mobilize and divide the blood vessel going into and out of the segment and the airway attached to the segment using a stapler.
In order to safely divide the segment away from other segments, we perform ICG angiography to determine the boarders of the segment. This is performed after dividing the vessel going into the segment and completed by injecting ICG in the blood stream, which turns green when it is viewed with the FIREFLY function on the robot. This provides a clear picture of the border between the segments and a stapler is used to divide the lung. A chest tube is placed in the area at the end of the case to remove any air or fluid.
Overall, the risks of the operation are very low. Risks may include pneumonia, atrial fibrillation, and prolonged air leak from the stapled lung. With any operation, there is a risk of injuring any structure that we operate around including the phrenic nerve, major vessels, pericardium, and diaphragm. Other risks may include bleeding and infection at the site of surgery. There is always a risk of needing to convert from a small incision to a larger incision to safely complete the operation.
Hospital Stay: 2 Days
After the operation, the patient goes to a recovery area called PACU or post-anesthesia care unit. Once the patient recovers from anesthesia, the patient is admitted to the floor. On average, patients are in the hospital for two nights. Patients start a regular diet during the night of the surgery along with pre-emptive pain control with around the clock pain medication. Every day, the chest tube is evaluated to determine if the tube can be safely removed. Once the patient’s chest tube is removed with good pain control, they are ready to continue the recovery at home.
Pain Management
We advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication at regular intervals. The typical regimen for post-operative pain medication is:
3 days of Aleve (Naprosyn) 1 tab two times a day
5 days of Tylenol (Acetaminophen) 1 g three times a day
7 days of Neurontin (Gabapentin) 300 mg three times a day.
After 7 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.
Activity
In order to further help with recovery from surgery, we advise patients to walk at least three times a day, work on the incentive spirometer, and sit in a chair for at least 6 hours a day for about a week after the surgery. We advise patients to avoid heavy lifting for 6 weeks. As long as the patient is not on narcotic pain medication, it is safe to drive.