Minimally Invasive Thoracic Surgery

Fox Chase surgeons Walter J Scott, MD, FACS, chief of thoracic surgery, and Abraham "Avi" Lebenthal, MD, are the area's most experienced surgeons in the use of video-assisted thoracic surgery (VATS) for lobectomy to treat lung cancer. With this technological advance, Dr. Scott and Dr. Lebenthal can offer potentially curative surgery to patients who might not have qualified in the past.

Benefit to Patients:

• reduced post-operative pain
• faster recovery
• shorter hospital stay
• reduced scarring
• minimal trauma to the chest wall
• improved survival rates

Surgical Treatment for Cancers of the Chest

Thoracic surgeons use VATS most often for removing a lobe of a cancerous lung through 2 to 4 small incisions. Conventional, open lobectomy usually requires making a 6- to 10-inch incision, cutting the major chest muscles, and spreading or even removing ribs. With VATS, these procedures are no longer necessary. Instead, the surgeon gains access to the chest by inserting a state-of-the-art telescope, video camera and surgical tools into a small space between the ribs.

Surgeons at Fox Chase use VATS to perform lung biopsies, pleural biopsies, wedge resections and lobectomies for patients with lung cancer, esophageal cancer, mediastinal tumors, Pancoast tumors and tumors of the chest wall.

Reducing the Need for Major Surgery

Dr. Scott was the first surgeon in the Delaware Valley to investigate the use of ultrasound bronchoscopy (endobronchial ultrasound) to evaluate lymph nodes in the chest, a procedure that can potentially reduce the need for invasive surgery. He also offers robotic surgery for chest tumors, using the ViKY® system — a robotically controlled holder for the scope and camera. This new robotic technology serves as a "third hand" for the surgeon, providing greater precision and control in VATS procedures.

Minimally Invasive Esophagectomies

Today, using minimally invasive techniques, such as VATS, surgeons can perform esophagectomies with fewer complications, improved quality of life and better outcomes, and without compromising oncologic principles.

Fox Chase is a longstanding and well-recognized regional center of excellence for esophageal surgery with very high surgical patient volumes. In esophageal surgery, both surgeon and institutional volume has been extensively correlated with patient mortality. Current surgical literature affirms that esophagectomies are preformed with the lowest expected patient mortality in this setting.

Dr. Avi Lebenthal is one of a few surgeons in the country to perform minimally invasive esophagectomies for patients with esophageal cancer. During his short time at Fox Chase, over 20 minimally invasive esophagectomies have been performed, the largest number in the Philadelphia area.

With conventional, open surgery, an esophagectomy required a laparotomy (accessing the abdominal cavity through an incision in the abdominal wall) and thoracotomy (a large incision between the ribs). A recent meta analysis of almost 1400 minimally invasive esophagectomies demonstrated a operative mortality that is approximately half of the accepted mortality for open esophagectomy.

Eating Normally Again

In early 2008, Jerry Vanderwoude began choking on his food at every meal. At first, he wrote it off to eating too fast or not chewing properly.

Jerry was surprised to learn that a growth on the wall of his esophagus was causing his choking. Fortunately, the esophageal tumor was benign.

Traditional surgery for an esophageal tumor involves cutting into the chest, which would have kept Jerry out of work for several months. Jerry had just started a great new job that he could not risk losing.

Then Jerry learned about an experienced thoracic surgeon with extensive expertise in minimally invasive esophagectomies using VATS who would be joining Fox Chase's staff within the month: Abraham "Avi" Lebenthal, MD. Read more

For more information about cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427).