What Is Single Incision Chest Surgery?

Today, with modern equipment, the surgeon's hands rarely enter the chest as the operation is done through video cameras and large television screens. Many surgeons around the world perform the operation through multiple keyholes (usually three), but surgical techniques developed by Professor Eric Lim allow the operation to be done through a one single 3-5cm incision, also known as uniportal surgery.

What Makes Single Incision Chest Surgery Different?

Before the invention of keyhole surgery, operations in the chest were routinely undertaken through a long cut in the side and back of the chest, with a small section of rib removed for lung operations or by sawing through the breastbone for diseases in the front of the chest. 

With single incision surgery, the rib is not removed, and the entire operation is done through one space between the ribs.

Which Conditions Can Be Treated?

Currently, Professor Lim offers single incision keyhole surgery for all chest-related surgical procedures, including surgery for lung cancer, pleural effusion, pneumothorax and also for mediastinal tumours. 

Step-by-Step: How the Procedure Works

You will first be seen by Professor Lim and the pre-operative process will be tailored to you, and the anaesthetic preparation and process will be the same as any other chest operation where you will be put to sleep, and a tube (bronchoscope) will be placed in your airway to ensure that there are no abnormalities, and to allow us to clear your airways from sputum is required to ensure optional breathing during surgery.

A single incision is undertaken either at the side of your chest for lung or thoracic procedures or under your breastbone for mediastinal procedures. The operation will be conducted by Professor Lim, and at the end of the operation, a drain will be placed into your chest. If there is no air leak or a very small one, the drain will be removed, allowing you to recover better and faster without a drain. If a drain needs to be placed, it will be connected to a bottle that you can bring home with you if required.

After surgery, if you have good pain control and no other issues, you will be allowed home on the same day or the next day or two, as appropriate, to how confident you feel, and / or if you develop any issues that need to be attended to.

Advantages for Patients

The advantages of single incision surgery in combination with drain-free surgery allow you to recover better with a shorter hospital stay and a single small scar. In addition, if the drain is removed, you won’t have pain due to the presence of a drain and will be able to move around more easily. 

Research undertaken by Prof Lim in the VIOLET study reported less pain and more mobility when the operation was performed through one keyhole, rather than multiple keyholes (with multi-portal VATS or robotic surgery).

Who Is a Suitable Candidate?

Most patients will be suitable for keyhole surgery at the outset, but conversion to open surgery is more likely if your tumour is very large or closer to a major structure. While there are many benefits for keyhole surgery, your safety and the success of the operation (e.g. to achieve cancer clearance) ultimately are much more important.

Recovery and Aftercare

In general, pain is usually very well tolerated, and the VIOLET study reported an average pain score in hospital of 3 out of 10. After surgery, you will be given painkillers to take that are required even if you are completely pain-free in the first 24 hours, as we use regional blocks that can wear off the next day(s). If you are allowed home the same day, you should be up and about and self-caring. With keyhole surgery, complete recovery can take up to 3 months and 6 months for open surgery, to achieve your baseline quality of health. You will be called on the same week to check up on your health and be seen in the clinic the next week for your results.

It would be very informative to download the app we created called PEACHealth which allows you to track your symptoms that can be sent to us before your clinic visit.

Why Choose Dr. Eric Lim for Single Incision Chest Surgery?

Professor Eric Lim is one of the pioneers of single incision keyhole surgery since 2010 and drain free surgery since 2016, with extensive clinical experience and published personal results to be able to advise you on chest operations.

Please contact me if you would like to book an appointment.