Video Assisted Thoracoscopy (VATS) Information for patients Thoracic Surgery

Video Assisted Thoracoscopy (VATS) Information for patients Thoracic Surgery

X X X This leaflet has been written to provide information about your procedure. We hope it answers some of your questions or concerns. It is not intended to replace talking with medical or nursing staff. What is a Video Assisted Thoracoscopy (VATS)? This is a procedure which allows the surgeon to examine your lungs and the area around your lungs (pleural cavity). The procedure is performed under general anaesthetic. Once you are asleep, the surgeon will make 1 to 3 small incisions (cuts) in the side of your chest. A thin tube with a light and camera on the end (thorascope) is then inserted through one of the cuts to allow the surgeon to see the lung and space around it (pleural cavity). page 2 of 16

At the end of the procedure whilst you are still asleep you will have a chest drain inserted to allow fluid and/or air to drain. This also aids expansion of your lung. Why do I need a VATS? Your surgeon will discuss with you before your operation what they intend to do for you and why they are doing it. The surgeon can perform specific tasks with a VATS procedure, for example: Removing small amounts of lung tissue or the lining of the lung (pleura) for examination in a laboratory (biopsy) Draining air or fluid from the area around the lung (pleural fluid) Removing part of the lung itself (lobectomy, wedge resection) Treat a collapsed lung (pleurectomy) Remove pus (decortication) page 3 of 16

Are there any side effects or risks with VATS? Major complications following VATS are rare. Common ones may include: bleeding at the incision / drain site infection at the incision / drain site pain at the incision / chest drain site Before you sign your consent form, the surgeon will discuss with you in more detail the risks involved with your procedure. It is important to be aware that the surgeon may not be able to complete the intended procedure with VATS and that an open procedure (thoracotomy) may be needed. What are the benefits of VATS? The procedure provides your doctor with important information. This may help to diagnose or rule out certain conditions, treat certain conditions, and/or determine best treatment options. If you are suffering with shortness of breath due to excess build up of fluid around your lung, then draining may help your breathing. The potential advantages of VATS over open surgery are a better appearance of scars, quicker recovery and less pain. Are there any alternatives? This depends on your condition and symptoms. Your doctor will be happy to discuss any alternatives with you. Other procedures that obtain samples of lung tissue are: Needle biopsy - a small needle is inserted through the skin under local anaesthetic. page 4 of 16

Bronchoscopy - a tube with a camera and light source is passed down your windpipe into your lungs to obtain a sample of lung tissue. To drain fluid from the lung cavity: Pleural aspiration - a needle is inserted through your chest under local anaesthetic to draw off fluid from the area around the lung (pleural space). How do I prepare for this procedure? Your general health and fitness will need to be assessed before your operation can take place. You will need some or all of the following: Chest X-Ray (CXR) - this shows basic information about your lungs and heart. ECG (heart tracing) - this records the electrical activity of your heart; its rate and rhythm Breathing test (respiratory function tests or RFTs) to show how well your lungs are working Blood tests tell us how your kidneys and liver are functioning MRSA screen (Methicillin Resistant Staphylococcus Aureus). MRSA is a common germ (bacteria) that is carried on the skin and in the noses of many people without causing any harm or infection. However if you have a surgical wound it may cause infection. All patients are screened before admission to see if they carry MRSA. We provide cream and body wash to treat this if you do carry this germ. Surgery is not usually cancelled. You may have some of these tests done on the same day you see your Consultant when you are referred for surgery or you will be sent an appointment to attend a pre-operative assessment clinic (POAC). page 5 of 16

Pre-Operative Assessment Clinic We ask that you attend this clinic to ensure all the information needed is available before your operation. The clinic appointment lasts 3 to 4 hours. Please bring all your medications with you so that we can review them before your upcoming procedure (or bring an up to date printed list from your GP). You will be seen by a nurse, a doctor / nurse practitioner and a member of the anaesthetic team This is also an opportunity to ask questions and discuss any concerns regarding your condition or care when you go home from hospital. You may wish to bring a family member or friend with you. Before you come into hospital, please give some thought as to how you will cope after discharge. During the first few weeks at home you may need practical as well as emotional support. Smoking We ask that you stop smoking before your operation, as continuing to smoke will increase your risks. Research shows that people who stop smoking have a shorter recovery period following an operation. We will offer you help with stopping smoking through an NHS support programme. We strongly advise you to take advantage of this offer of help. Please ask for a copy of the 'Stop before your op!' advice leaflet which is available in the pre-operative assessment clinic. page 6 of 16

Coming into hospital You will be admitted to hospital either on the morning of surgery or the afternoon before. We will discuss this with you at the pre-operative assessment clinic. You will be admitted to the Cardio-thoracic Theatre Admission Unit (CTAU) or Chesterman 3 ward. We ask that you bring all your medications with you, in their original packs, for use during your stay. You will be seen by: The anaesthetist who will discuss how they will look after you, answer any questions you may have and also advise you when you need to stop eating and drinking before surgery. The surgeon who will discuss your surgery with you and obtain your written consent. He/she will also mark the operation site with a skin marker pen - so you know that the correct area of lung is being operated on. We must seek your consent for any procedure or treatment beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent. If you are unsure about any aspect of the treatment or procedure proposed, please do not hesitate to ask for more information. Day of Surgery Admission (DOSA) If you are to be admitted on the day of surgery, you will be asked to report to the nurse in the Cardio-Thoracic Theatre Admission Unit (CTAU). This is situated between Chesterman 3 and Chesterman 4 wards on D floor, Chesterman building. page 7 of 16

The day of surgery You will be taken to theatre by a nurse and a support worker. On arrival at theatre another nurse will take over your care. How long does it take? The procedure takes approximately one hour. However, you will be away from the ward for 3-4 hours as time spent in the anaesthetic room and recovery area can vary from person to person. After your surgery When your operation has finished, you will be taken to the theatre recovery area. You will stay there until you are awake, comfortable and ready to return to the ward. You will be wearing an oxygen mask to help you recover from the anaesthetic. On return to the ward the nurse will check your pulse and blood pressure regularly. You will have a drip to give fluids until you are able to drink. You will be allowed food when you are tolerating fluids. The nurses will assist you with your wash and hygiene needs until you are up and about by yourself. What about the chest drain(s)? This is a tube which the surgeon will put in place at the end of your operation whilst you are still asleep. It is about the width of a finger or pen and allows drainage of air and/or fluid from your chest cavity and aids lung expansion. The chest drain is removed by the nursing staff on the ward when it has stopped draining fluid and air. When the drain is removed there will be a stitch left behind to close the skin. This will need to be removed 5 to page 8 of 16

7 days later. The ward nurses will arrange for the community nurse or practice nurse to do this as you are usually at home by this time. It is normal to have a chest x-ray following your procedure and after removal of the chest drain. Is it painful? Pain is a very personal thing, however it is anticipated that you may experience some pain or discomfort after VATS procedure. The relief of pain is very important for your recovery and we have various ways of managing any discomfort you might feel which we will discuss with you before and after your procedure. All patients will have some form of painkiller to take home with them. How long will I be in hospital for? This varies, but the average length of time most patients can expect to be in hospital is between 3 to 7 days following a VATS procedure. You are usually discharged the day after the chest drain is removed. When can I start normal activities? It is normal for you to feel tired and a little anxious when you first go home. Recovery can vary from 2-8 weeks, everyone is different. You may drive after 2 weeks, if your pain is well controlled. You should take at least 2 to 6 weeks off work. Avoid contact sports for 2 weeks. You may need help from family/friends with heavy housework and shopping for a few weeks If you live alone or have concerns about how you will manage when you go home from hospital please discuss this before surgery at the pre-admission clinic. page 9 of 16

Your wound Following this procedure you can bathe/shower as you wish. Your wounds can get wet - we advise that you pat the area dry with a clean, dry towel. Please do not rub or apply creams or talcum powder or spray deodorant directly to the area until the skin is fully healed. if you have the choice of showering or having a bath, choose a shower for the first two weeks after surgery. If you have to use a bath, we recommend the following: do not soak for long periods for the first 6 weeks empty the water out before you get out place a non-slip mat in the bath you may need assistance to get out of the bath Moving around When you go home, move around regularly. Try to increase how far you walk each day; include walks outside if you are able to and your general health allows you to do so. Most patients are required to wear anti-embolic stockings for up to 6 weeks after surgery. You will be provided with 2 pairs to take home. Eating and drinking Continue to try to drink 1-2 litres of fluid each day. Continue to eat a well-balanced diet. You may find it easier to eat small, more frequent, meals until your appetite returns. If you need help or advice regarding your diet or appetite, your GP will be able to arrange for a dietitian to advise you. page 10 of 16

Pain management You will be given a supply of pain relief medication to take home with you. Continue to take your pain relief medication regularly for the first week after discharge. It is a good idea to slowly reduce your pain relief medication over a period of time rather than stop it completely. Your GP can advise you on this. Your breathing Continue your breathing exercises. You may find that you get breathless after activity but this should improve with time. Some of you may suffer with breathing problems, such as asthma or COPD, and may still get breathless at times. You may find that you still cough up phlegm for a period after surgery. If you have any concerns or problems with your breathing, you must seek medical advice. In addition to the written advice we are happy to answer any questions you or your family may have during your stay. Day of discharge The doctors will decide when you are medically fit for discharge and the nurses will discuss your discharge arrangements with you and your family. Generally we like to give at least 24 hours' notice prior to discharge. However if you or your family have any worries or concerns regarding your forthcoming discharge, then we ask that you discuss this with us as soon as possible. The nurse looking after you will co-ordinate your discharge, eg checking your medication and your transport arrangements, and will also check whether or not you need a community nurse or practice nurse. page 11 of 16

Transport You will need to make arrangements to be picked up by a relative or friend or a taxi as hospital transport is restricted to those with specific mobility needs. You will need to be collected from the ward before 10.00am. If this is not possible, you will be asked to wait in the hospital discharge lounge. Discharge lounge We have a discharge lounge at the Northern General and we ask that you wait here for your transport or medications. Doing this allows a bed to be available for routine and/or emergency admissions. The discharge lounge is staffed by nurses who are there to look after you until you leave the hospital. What follow-up care will I need? You will be reviewed in the out-patients department, usually 2-6 weeks following your discharge. The doctor/practitioner who sees you will check your wound and review your general recovery and condition. You will also have a chest X-ray. Please bring in your medications so that the doctor can review these if needed. If you had a tissue sample (biopsy) or fluid taken for examination you will be given the results by your consultant or one of his/her team. Your plan of care following these results will be discussed with you. If you have been discharged with a drain still in place, you will need to return for review on a weekly basis to the nurse-led drain clinic which is based on the ward. page 12 of 16

Is there anything I should look out for when I go home? If you or your family/carer is concerned about any aspect of your recovery at home, you can contact the nursing team on Chesterman 3. Depending on the nature of your enquiry, one of the following will happen: Advice will be given to you over the phone You will be asked to attend the next nurse-led clinic You will be asked to attend the ward You will be advised to ring your GP You will be advised to attend your nearest Accident and Emergency department In emergencies please call 999. Remember you must seek medical advice for the following: Continued problems with constipation despite taking a laxative and eating a high fibre diet Your wound becomes more red than before and warm to touch Your wound becomes swollen Your wound has discharge coming from it Any part of your wound appears to be coming apart Your pain becomes worse despite taking your recommended dose of painkillers Your breathlessness becomes worse and you or your family are concerned page 13 of 16

Who can I contact if I have any questions or concerns? Secretaries: 0114 226 6811 or 0114 226 9279 Chesterman 3: 0114 271 4335 or 0114 271 4419 Clinic Call Centre: 0114 226 9199 Cardio-Thoracic Theatre Admission Unit (CTAU): 0114 226 9425 (7.00am - 3.00pm) Lung Support Specialist Nurses (via Northern General Hospital switchboard) 0114 243 4343 page 14 of 16

Where can I find out more information? NHS Choices www.nhs.uk British Lung Foundation www.lunguk.org Mesothelioma UK www.mesothelioma.uk.com Healthtalk online (people's experiences of a range of health issues) www.healthtalkonline.org page 15 of 16

Important dates Pre-operative assessment Date: Time: Date of surgery Date: Time: How to find us Chesterman Out-patient Department Entrance 10 C Floor, Chesterman Wing Northern General Hospital Herries Road Sheffield S5 7AU Chesterman 3 & Cardiothoracic Theatre Admission Unit (CTAU) Entrance 11 D Floor, Chesterman Wing Northern General Hospital Herries Road Sheffield S5 7AU Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5361-PIL1766 v6 Issue Date: October 2017. Review Date: October 2019