University College Hospital at Westmoreland Street Thoracic surgery by keyhole (VATS) Information and advice for patients, relatives and carers
2 If you would like this document in another language or format, or require the services of an interpreter, contact us on 020 3456 7898. We will do our best to meet your needs. Contents 1. Introduction 3 2. What does VATS mean? 3 3. How can VATS help? 3 4. What happens during VATS? 4 5. What are the risks involved with VATS? 4 6. What will happen if I choose not to have VATS? 5 7. What alternatives are available? 5 8. How should I prepare for VATS? 5 9. Admission to hospital 7 10. Asking for your consent 8 11. What should I expect after VATS? 8 12. Contacts 11 13. Where can I get more information? 12 14. How to find us 13
3 1. Introduction This leaflet provides information about having Video Assisted Thoracoscopic Surgery (VATS), also known as keyhole surgery, and caring for a loved one who is having VATS. The care and treatment that you/your loved one will receive will be specific to your/their needs. 2. Video Assisted Thoracoscopic Surgery VATS is a type of keyhole surgery where incisions are made to the chest, and a special instrument with a tiny video camera is inserted into one incision by the Surgeon. The camera feeds video images to a computer screen, allowing the Surgeon to see what is happening inside the chest. The Surgeon usually inserts other special surgical instruments into the other incisions. These instruments can be used to remove tissue which may have been seen on an X-ray, or fluid in the chest. Once the surgery has finished, the instruments are removed. 3. How can VATS help? VATS is used for: Taking biopsies from the lung or the lining of the chest wall Removing abnormal nodules from the lung Draining pleural effusion (where fluid builds up in the lining of the lung) Removal of a cancerous tumour (wedge resection) Pneumothorax (where a lung has collapsed) Bullectomy (to remove Bullous disease) Pulmonary lobectomy in suitable cases
4 4. What happens during VATS? The Surgeon will have discussed with you the risks and benefits of the surgery, and you will have had the opportunity to ask questions and get answers about the procedure beforehand, and when you sign your consent form. Your operation will be performed under general anaesthetic. The Surgeon makes up to three two-centimetre incisions in your chest and inserts a thoracoscope into one hole. The camera in the thoracoscope will show video images of the inside of your chest onto a computer screen, enabling your Surgeon to perform the surgery. The Surgeon can then insert special surgical instruments into the other incisions to carry out the surgery. Once the surgery has finished, the instruments are removed. One incision is closed with stitches and one is used to drain excess fluids or air. 5. What are the risks involved with VATS? All treatments and procedures have risks, and your Surgeon will talk to you about the risks involved with VATS. Problems that may occur straight away: Air leaks Bleeding Problems that may occur later: Chest infection Wound infection Problems that are rare but serious: Other risks involved in using general anaesthesia (these will be explained to you).
5 6. What will happen if I choose not to have VATS? You can choose not to have your procedure this way, but when you were assessed, this was thought to be the best approach. If you have any reasons for not wishing to go ahead with this procedure, your chest Doctor, chest Surgeon and Clinical Nurse Specialist (CNS) will do everything they can to support you. 7. What alternatives are available? Your treatment plan is based on a very well-considered and discussed assessment of your condition and is thought to be the most appropriate way of treating your lung problem, establishing a diagnosis or for relieving your symptoms. Please take time to discuss your options with your chest Doctor, Surgeon or CNS who will explain everything as clearly as possible to you. 8. How should I prepare for VATS? Pre-assessment: You will need to attend a pre-assessment clinic to have some or all of the following: Blood tests Chest X-ray ECG (Electrocardiogram a simple and useful test that records the heart s electrical activity). MRSA screening (a simple nose swab to test for Methicillin-Resistant Staphlococcus Aureus a type of bacterial infection that is resistant to a number of antibiotics. Screening helps reduce the chance of patients developing an MRSA infection or passing an infection on to other patients).
6 During the pre-assessment you should tell the Doctor or Nurse if you will need help after the operation. Please make arrangements for a relative or friend to bring you into hospital and collect you afterwards. Eating well: Continue to eat a balanced diet so that you are in the best condition possible for surgery. Support at home: Before you come into hospital, please make arrangements for someone to help you with shopping, cooking and housework while you are recovering. The chest Physician who referred you to the chest Surgeon will have discussed the reasons for referring you, and ordered special investigations, such as CT scans. The things you can do to help yourself before surgery are: Stop smoking: If you smoke you will be advised to stop before surgery, as this reduces the chance of breathing problems and developing a chest infection. Reduce alcohol intake: If you drink more alcohol than the recommended amount (21 units for a man and 14 for a woman) you will need to reduce your intake before your surgery. Alcohol can make you dehydrated if you are going to fast for a long period of time. Fast: You will have a general anaesthetic and we will ask you not to eat or drink for a certain length of time before the procedure. The Anaesthetist, Surgeons and Nurses will provide you with information about this. If you are taking anticoagulants such as warfarin, dabigatran (Pradaxa ), rivaroxaban (Xarelto ) or apixaban (Eliquis )please check with the doctor or surgeon if they need to be stopped and for how long. The exact duration to stop may differ depending on the reason you are taking them and in some instances we may need to give you alternative to take before surgery.
7 You should bring the following items with you to hospital: Dressing gown, nightdress or pyjamas Slippers Toiletry bag and toiletries All medication that you normally take Loose change (for newspapers, etc.) Mobile phone. Please don t bring jewellery, valuables or large amounts of money. 9. Admission to hospital You will receive information from your Surgeon s Secretary with clear instructions for you to follow. There are two pathways for patients coming in for VATS: Pathway A and Pathway C. The letter from the Secretary will tell you which pathway you will be on. If you are on Pathway A you will be admitted the night before your surgery. If you are on Pathway C you will be admitted on the day of surgery, and be given information about fasting. When you arrive The Surgeons, the Anaesthetist and the Nurse will complete the final pre-operative check list. If you have not been pre-assessed you will need to have MRSA screening, blood tests, ECG, chest X-ray and a shower. If you do not have these, your surgery may be affected or delayed.
8 Thrombo-embolic Stockings: Before going to Theatre you will be given Thrombo-embolytic Stockings (TEDs ) - a pair of firm elastic socks to wear to help prevent blood from collecting in the legs and causing clots. You need to wear them until you are discharged home. The Nurses will also give you small injections, usually in the stomach, to ensure you are not at risk from blood clots. 10. Asking for your consent We want you to be fully involved in all decisions about your care and the procedure. If you decide to go ahead with the procedure, by law we must ask for your consent and ask you to sign a consent form. This confirms that you agree to have VATS and understand what it involves. Your Surgeon will have already discussed with you the benefits and risks, taking into account your general health. However, you may also want to ask the Anaesthetist the same questions. Please ask about anything that is on your mind. We want you to be fully informed about the procedure and happy about signing a consent form. 11. What should I expect after VATS? Recovery: You will wake up in the recovery area, in the Critical Care Unit. The Nurses will inform your relatives and loved ones that you have arrived and when they can visit. When you first wake up from the anesthesia, you may feel groggy, thirsty or cold. If the breathing tube given to you during surgery remains in place, you won t be able to talk. Chest drain: During the operation, your lung is deflated. To enable it to re-inflate and to drain away any fluid and air, a flexible tube is inserted in the space between the lung and the chest wall. It is then
9 attached to a bottle on the floor. This will be attached to wall suction. After the operation, a Nurse will regularly check this to make sure your lung is re-inflating. The Nurse will monitor the amount and type of drainage and whether there are bubbles of air in the bottle. The chest drain will be removed when it is no longer required. Oxygen: After your operation you will be given oxygen via a mask to manage your oxygen levels whilst you recover. Pain: A Nurse will give you medication to lessen any pain. Eating and drinking: You should start eating and drinking when you feel ready. It is often best to start with small, nutritious snacks and gradually build up to a normal diet. If you have lost weight prior to your operation, the Nurses may offer you nutritious drinks and snacks and may send a Dietitian to see you. Bowels: Regular bowel movements may be affected by surgery. To encourage bowel movement, take plenty of fluids and move around whenever possible. Painkillers often cause constipation so your Doctor will prescribe laxatives to accompany them to ensure you do not become constipated. Moving around: We encourage you to breathe deeply, cough, move around and exercise your arms and shoulders (especially on your operation side). The nursing staff will encourage you to sit in a chair by the bed on the first day after your operation and, later, to walk around the ward. This can help prevent a chest infection and clots in the leg. If you have any difficulties the Physiotherapist will visit you. Wound: The Nurses will clean and dress your wound as needed. They will arrange for the District Nurses to check your wound when
10 you go home. Hospital stay: The hospital stay after VATS is three days, but it can be longer if there are any complications. Medications: When you go home we will supply you with any new medication you might need such as painkillers or laxatives. Please ensure you have your own supply of your usual medications. Your GP will provide you with any further supplies as needed. Practice Nurse: The Ward Nurse will refer you to the Practice Nurse once you have gone home. You will visit the Practice Nurse to have stitches removed and ensure your wound is healing well. Pain relief: We will give you one week s supply of painkillers to take home. It can take a while for the pain to settle and so you will need to visit your GP for further pain relief. It is normal to feel numbness, burning and tingling around the side of your chest where the wound is, and around the front of your chest. In some people this may take up to six weeks or more to fully settle.
11 12. Contacts University College Hospital at Westmoreland Street The old Heart Hospital 16-18 Westmoreland Street, London W1G 8PH If you are waiting for your biopsy results, or if you already have a diagnosis of cancer, your local Lung CNS from your referring Doctor is available to support you and your family during this time. If you are having problems contacting your local Lung CNS, please call the Thoracic CNS at University College Hospital at Westmoreland Street who will be able to advise you. CNS direct Line: 020 3456 6053 or 020 3456 6047 Bleep: 6993 Extensions: 66053 or 66047 CNS email: CNSThoracicSurgery@uclh.nhs.uk Secretaries: Medical PA to Mr Lawrence and Mr Panagiotopoulos: 020 3456 6059 Medical PA to Mr Hayward & Mr Kolvekar: 020 3456 6046 Fax: 020 3456 6062 Switchboard: 020 3456 7898 Fax: 020 3456 6062 Website: www.uclh.nhs.uk
12 13. Where can I get more information? If you would like any further information about VATS, or if any problems arise, you can telephone any of these numbers: British Lung Foundation Helpline telephone: 03000 030 555 Helpline email: helpline@blf.org.uk (Monday to Friday, 10:00 to 18:00). Website: www.blf.org.uk NHS 111 Dial 111 Macmillan Support and Information Centre University College Hospital Macmillan Cancer Centre Huntley Street, London WC1E 6AG Tel: 020 3447 8663 Email: supportandinformation@uclh.nhs.uk NHS Smokefree (Services to help you stop smoking) Telephone: 0300 123 1044 (Monday to Friday, 09:00 to 20:00 or Saturday and Sunday, 11:00 to 16:00) Website: www.smokefree.nhs.uk Cancer Research UK Nurse helpline: 0808 800 4040 Website: www.cancerresearchuk.org Email: supporter.services@cancer.org.uk The Roy Castle Foundation Telephone: 0333 323 7200 Website: www.roycastle.org Email: info@roycastle.org
13 13. How to find us Public transport to University College Hospital at Westmoreland Street By bus: Portland Place - no's 88, C2 Marylebone Road - no's 18, 27, 30 Oxford Street (Bond Street Station) - no's 7, 8, 10, 25, 55, 73, 98, 176 By Tube: Bond Street (Central / Jubilee Lines) Regents Park (Bakerloo Line) Baker Street (Bakerloo / Circle / Hammersmith & City / Jubilee / Metropolitan Lines) University College Hospital at Westmoreland Street 16-18 Westmoreland Street London W1G 8PH Telephone: 020 3456 7898
Space for notes and questions
Publication date: November 2014 Last review date: June 2015 Next review date: June 2016 Leaflet code: UCLH/SH/HH/VATS/1 University College London Hospitals NHS Foundation Trust