Single incision keyhole surgery

I love a challenge. In all aspects of thoracic surgery practice and lung cancer care, I have sought to consistently improve on the quality of surgery and care. When  I started independent practice, the vast majority of my operations were performed through an open thoracotomy, with time this was replaced by three keyholes and now with one keyhole. The average length of stay after lung resection surgery in 2008 was 7 days and by 2015 it was 2 days. Striving to improve clinical care using better skills, better equipment, better pain control, better post-operative care and a better team approach has been responsible for an overall better experience and a short hospital stay, even for major lung surgery.

Within three finger breadths

Most of my operations are now performed by keyhole surgery with an incision is no longer than three finger breadths. Actually we start the incision with two finger breadths, but with soft tissue retraction the end result is slightly larger. The single incision keyhole approach is now my standard approach for major lung resections.

Not all patients are suitable for keyhole surgery, those with central cancers in whom a major airway or blood vessel may need to be reconstructed will still require their surgery undertaken through a formal open (thoracotomy) approach. In addition I would convert to an open thoracotomy if the keyhole approach is not deemed possible for technical reasons or if I encounter any difficulties during the surgery to ensure that you operation can continue in the safest manner.

Within two days

We don’t aim to kick you out within two days as part of a government drive or target to reduce hospital length of stay, but we do strive to get you pain free and well enough to be ready such that you can choose to go home in two days if you wish. By the morning after surgery we aim to for you to have “no pain and no drain”, but please be aware that we do not achieve this in all patients.

The ability to achieve “no pain and no drain” in many patients the morning after surgery reinforces our drive to achieve it consistently because of the satisfaction of spotting our patients in the park the day after a major lung resection.

Within one keyhole

A lot can be done in one keyhole less than three finger breadths. The majority of my operations including pleural biopsy, lung biopsy, surgery for pleural effusion, pneumothorax  and major lung resections are performed with only one keyhole.

Patients often wonder how so much can be done through such a small incision and so here is a video example of how I perform a lung resection through a single keyhole.