1. Nursing Instruction
  2. Overview
  3. Thoracic Surgery
【Major Points】
  1. Video-assisted thoracoscopy is mainly used for examination, diagnosis, staging, and treatment of thoracic diseases.
  2. Preoperative preparations include medical condition explanation, preoperative anesthesia visit, and deep breathing exerciser training.
  3. After surgery, the drainage tubes should be fixed properly and not be knotted, nor compressed.
  4. Patients with signs of infection, such as redness, swelling, heat, and pain, should return to the clinic.

What is thoracoscopic surgery?
Thoracoscopic surgery, also known as minimally invasive surgery, is performed under general anesthesia with 1-3 wounds of about 1-2 cm on the lateral side of the chest, and the surgery is performed under the assistance of endoscopic imaging. Compared with the 20 cm wound of the traditional thoracotomy, the wound caused by thoracoscopic surgery is smaller, there is less pain, and the speed of recovery is faster.
          
Why is this surgery needed?
Thoracoscopy is mainly used for examination, diagnosis, staging, and treatment of thoracic diseases. When medical problems are identified, such as lung tumor, pneumothorax, empyema, chest trauma, or mediastinal tumor and so on, the surgeon will further evaluate and decide whether thoracoscopic surgery is required.

Preoperative preparation:
  1. All related examinations should be completed before surgery, including chest X-ray, electrocardiogram, blood tests, and pulmonary function test.
  2. A respiratory therapist will teach you techniques such as diaphragmatic breathing, coughing, and provide you a breathing exercise device.You should practice these breathing exercises at least four times a day, and at least 6-10 times per round.
  3. Pre-operative anaesthesia visit will be scheduled.
  4. Before the surgery, the thoracic surgeon should explain the medical  condition and surgical methods to the patient and their family members, who would fill in the consent forms for surgery, anesthesia, and self-paid items.
  5. Patients should quit smoking for at least 2 weeks to maintain lung function, reduce sputum production, and make the lungs expand well.
  6. Patients are not allowed to eat or drink after midnight the night before the surgery to avoid vomiting during anesthesia, which may cause aspiration pneumonia.

Principles of post-operative care:
  1. After the surgery, the wound should be kept clean and dry, and nursing personnel should be notified if the gauze is wet.
  2. Patients can choose pain relief methods according to their needs. In addition, they will take painkillers after surgery to reduce pain.
  3. After the surgery, there will be an IV drip, urinary catheter, and chest drainage tube on the body. Each tube must be fixed properly and not be kinked or compressed, in order to maintain the normal function of each tube, especially the chest tube, which is the most important. If there is a chest tube indwelling, it is necessary to adopt a semi-sitting position to facilitate drainage function.
  4. Patients should start getting out of bed at the next morning after surgery. The first time getting out of bed should be assisted by nursing personnel to facilitate lung expansion.
  5. Patients should not take traditional Chinese medicine or supplements after surgery but should eat more high-protein and high-vitamin foods, such as eggs, beans, fish, dark green vegetables, and fruits, to improve wound healing.

Precautions when returning home:
  1. If the wound is covered with cosmetic tape, patients must keep it clean and dry, and there is no need to change the dressing nor remove the stitches. Observation of the general  wound appearance is required. The dressing of the suture wound must be changed every day, and the wound should be observed if   infection signs, such as redness, swelling, local heat, pain, and purulent discharge. In case of the aforesaid situations, patients must return to the thoracic surgery outpatient clinic immediately.
  2. Patients may have intercostal pain for 3-6 months after surgery, thus, they will take oral pain relievers when they are discharged from the hospital. Patients should take the medicines according to the surgeon's instructions.
  3. Patients should avoid lifting heavy objects (less than 3 kgs) within one month after surgery. They should take simple exercises, such as walking, climbing stairs, and morning exercise, and often do deep breathing and coughing exercises. Patients may continue to perform breathing exercises, as provided by the trainers to increase lung capacity.
  4. Patients should take the prescribed drugs on time and follow-up with the surgeon.
 
Reference
  1. Ferreira, V., Minnella, E. M., Awasthi, R., Gamsa, A., Ferri, L., Mulder, D., Sirois, C., Spicer, J., Schmid, S., & Carli, F. (2021). Multimodal Prehabilitation for Lung Cancer Surgery: A randomized controlled trial. The Annals of Thoracic Surgery, 112(5), 1600–1608. https://doi.org/10.1016/j.athoracsur.2020.11.022
  2. Hernandez-Vaquero, D., Vigil-Escalera, C., Perez-Mendez, I., Gutierrez, A., Avanzas, P., Wei, Y., Diaz, R., Silva, J., Moris, C., & Pascual, I. (2021). Survival after thoracoscopic surgery or open lobectomy: systematic review and meta-analysis. The Annals of Thoracic Surgery, 111(1), 302-313. https://doi.org/10.1016/j.athoracsur.2020.05.144
  3. Lim, E., Batchelor, T. J. P., Dunning, J., Shackcloth, M., Anikin, V., Naidu, B., Belcher, E., Loubani, M., Zamvar, V., Harris, R. A., Dabner, L., McKeon, H. E., Paramasivan, S., Realpe, A., Elliott, D., De Sousa, P., Stokes, E. A., Wordsworth, S., Blazeby, J. M., & Rogers, C. A. (2022). Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM evidence, 1(3), EVIDoa2100016. https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100016
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    1. Nursing Instruction
    2. Overview
    3. Thoracic Surgery
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    Surgery / Procedure
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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