Thoracic Surgery

Lahey’s thoracic surgeons may treat extensive esophageal cancer with an advanced procedure called esophagectomy. In this procedure, our surgeons remove all or part of the esophagus and then rebuild it from part of the stomach or intestine.

Robotic assisted esophagectomy (RAMIE) uses a thin high-definition camera and small instruments to remove the esophageal cancer without requiring large and debilitating incisions. Lahey’s thoracic surgeons perform a large number of these esophagectomy procedures, and our experience has produced excellent outcomes for our patients.

In people with gastroesophageal reflux disease (GERD), stomach acid moves upward into the esophagus and causes heartburn. Symptoms of heartburn sometimes lead to long-term use of anti-acid medications. Unfortunately, these medications often become ineffective with prolonged use, are costly, and over time, this acid can damage the tissues of the esophagus and lead to cancer.

GERD is often caused by hiatal or paraesophageal hernia. In these conditions, the stomach and lower part of the esophagus, slip from the belly into the chest. This can create pain and acid reflux.

At Lahey Clinic, our thoracic surgeons use minimally invasive laparoscopic techniques to repair hiatal hernias and eliminate GERD. The surgeon uses tiny incisions to introduce cameras and small instruments laparoscopically to reposition the esophagus and stomach in the proper place and create a valve to stop acid reflux.

Lahey thoracic surgeons also use advanced robotic surgery to treat these esophageal conditions.

Thoracic specialists at Lahey have substantial experience and expertise in treating lung cancer. Our experience and team approach allow us to provide patients with lung cancer the very best possible outcomes.

Lahey is at the forefront of robotic lung cancer surgery, including robotic lung resection, which has been shown to be an effective treatment for early-stage lung cancer.

Surgical resection for lung cancer may involve the removal of a small portion of the lung (segmentectomy or wedge resection), a lobe of the lung, or occasionally an entire lung to achieve complete removal of the cancer and ensure normal breathing after surgery.

What to Expect with Robotic Lung Resection

We perform robotic thoracic surgery in our special robotic surgery suite while you’re asleep under general anesthesia. The surgeon makes four small incisions on your side. They insert special surgical instruments and a scope with a tiny video camera at the end, all connected to the arms of the robot.

The robot cannot move by itself. The surgeon sits at a nearby console. They control all of the robot’s movements while watching the progress on a three-dimensional video monitor. The da Vinci Xi robot has instruments that move as the surgeon moves their fingers, hands and wrists. This gives the surgeon excellent dexterity, precision and control.

The surgeon removes the affected portion of the lung and nearby lymph nodes through one of the incisions. The surgical instruments are then removed. The incisions are closed with absorbable sutures (stitches).

How Robotic Lung Resection Benefits You

At Lahey, you can expect these and other benefits from robotic lung resection.

• Smaller incisions allow you to recover more quickly and get back to your daily activities sooner.
• Less pain compared to standard incisions. The chest wall is sensitive, and surgery can aggravate the nerves within it. But robotic procedures can be done with smaller incisions in the lower part of the chest where there’s more space between the ribs.
• Quicker return home. Everyone’s recovery is different, but some Lahey patients go home as soon as two days after surgery. This speed results from the expertise of our surgeons and the use of the da Vinci Xi robots.
• Better able to learn if cancer has spread. Robotic lung resection allows for more careful and thorough dissection of the lymph nodes, where lung cancer might be hiding. Knowing if cancer is present in the lymph nodes helps determine the stage of the cancer. Knowing if the cancer has spread allows us to plan for other treatment, if needed. The da Vinci robot allows the surgeon to thoroughly dissect each lymph node. If lymph nodes are affected by the cancer, chemotherapy greatly helps survival.
• Our dedicated thoracic robotic surgery nursing team is skilled at important aspects of robotic procedures and the specialized instruments used by the surgeons. This gives you seamless, coordinated surgical care.
• Our dedicated nursing and physician assistant team routinely cares for our thoracic surgical patients after surgery. We know that your care after surgery is just as important as care during surgery.

Achalasia

Achalasia is a condition in which the nerves of the esophagus become damaged. It can cause chest pain, difficulty swallowing, heartburn, and other symptoms.

Lahey’s thoracic surgeons treat achalasia with minimally invasive laparoscopic techniques, in which special thin instruments and a miniature lighted camera are inserted through tiny incisions. The camera sends images to a video screen, which the surgeons use to guide their progress. This state-of-the-art procedure, called laparoscopic Heller myotomy, produces excellent patient outcomes.

In certain situations, the surgeons at Lahey can treat achalasia using a leading-edge completely “incision-less” procedure that is performed endoscopically (using a thin camera placed down the throat). This procedure called POEM (Per-Oral Endoscopic Myotomy) produces little to no pain, rapid recovery, and excellent outcomes for patents with achalasia.

Esophageal Narrowing

The esophageal team at Lahey has a variety of advanced techniques for treating esophageal narrowing, also known as “stricture” or “stenosis.” Esophageal narrowing can be caused from chronic acid reflux, injury, or infection.

The thoracic surgeons at Lahey use esophageal endoscopy with dilation (gentle stretching procedure), stenting, and in certain circumstances, surgery, to open the area of narrowing and improve a patient’s ability to swallow. Oftentimes, these procedures are performed as day surgery and the patient can go home the same day as the procedure.

Treatment of severe chronic obstructive pulmonary disease (COPD) is complex and requires a team of experts. At Lahey our thoracic surgeons participate in a multidisciplinary team along with our expert pulmonologists, interventional pulmonologists and pulmonary rehabilitation specialists to determine if surgical lung volume reduction (LVRS) is right for you.

Surgical lung volume reduction involves removing diseased lung tissue at the top of the lungs to improve air flow to the healthy parts of the lung and improve the function of the diaphragm. This results in improved quality of life, improved shortness of breath, increased lung function and exercise capacity.

All LVRS surgeries are performed as minimally invasive procedures utilizing small incisions either by using robotic assistance or with VATS to minimize post-operative pain and recovery time. Our patients are followed closely both before and after surgery to monitor their progress and to ensure they continue to improve following surgery.