What to Expect Before, During and After Robotic Surgery

Robotic surgery offers doctors more flexibility to safely perform complex procedures with fewer complications than traditional surgery. Robot-assisted surgery is minimally invasive and usually ensures a rapid recovery. Patients can prepare by learning more about the procedure.

What Is Robotic Surgery and Why Am I Having it?

Robotic surgery uses a particular set of technologies to help surgeons carry out procedures that would otherwise be more time-consuming, painful or complicated. In addition to mechanical arms with precise surgical instruments, the computerized system includes a camera, a magnified viewing screen and a control console.

Dr. Fontaine and his team use this system to perform one of three surgeries, depending on the patient’s needs: pneumonectomy, lobectomy or segmentectomy.

• Pneumonectomy: Removal of the entire right or left lung.
• Lobectomy: Removal of a lobe. The right lung consists of three lobes and the left has two lobes.
• Segmentectomy: Removal of a segment that makes up a portion of a lobe.

What Should I Do Before Robotic Surgery?

Before your surgery, prepare by participating in regular daily activities, such as moderate walks or stretching exercises. Frequent light exercise, along with support from family and friends, will increase your chances for a rapid and successful recovery.

If you currently smoke, the surgical team highly recommends you quit before your procedure, especially if your surgery is at least two weeks away. After you quit smoking, your airways produce more phlegm for about two weeks, and this can make your recovery more difficult. Speak with your family physician about smoking cessation strategies and to get information on support groups.

Medication, Food and Drink Guidelines

Patients should follow these guidelines for taking medication or food and drink before their procedure:

• Stop blood thinners such as Coumadin (warfarin) or Coumadin (clopidogrel) at least five days before your procedure.
• Do not eat or drink anything after midnight the night before your procedure.
• You may take your morning medications with a sip of water the morning of surgery, but do not eat or drink anything for breakfast.
• You may continue taking aspirin or other anti-inflammatories such as Advil or Motrin (ibuprofen) even on the morning of surgery.
• If you are taking medication for diabetes, take half of your normal dose.

What Should I Expect on the Day of My Robotic Surgery?

Knowing what to expect on the day of your procedure can help make the day as stress-free as possible.

Admitting Procedures

Plan to arrive at the H. Lee Moffitt Cancer Center in Tampa about two hours before your scheduled surgery time. Patients can choose to use the complementary valet service for parking. Check in at the Surgical Admissions desk and they will provide you with further assistance.

Family and friends may accompany you until the time of your surgery, after which they must wait for you in the Surgical Waiting Area until your surgeon comes out to speak with them. Delays or changes in the operating room schedule are not uncommon and should not alarm or worry them.

What Happens in the Operating Room?

In some cases, before administering anesthesia, your surgeon will place a thoracic epidural catheter in your spine. This catheter is a small plastic device that helps with pain management after your surgery and will decrease feeling around the surgical site.

Once you receive general anesthesia, you will be completely asleep for your surgery and unable to feel or remember the operation.

Minimally invasive surgery is completed using video-assisted technology (VATS) or robotically assisted technology (robotic surgery). This method requires four small cuts along with the use of a camera and special instruments.

In cases that require additional techniques or safety measures, your surgeon may switch to an open, traditional method using a single five to seven-inch cut along your side and underneath your shoulder blade.

During the surgery, your operated lung is temporarily collapsed and special staplers are used to cut and seal the blood vessels and branches of windpipe (bronchus) supplying that lung tissue. Once the lung or portion of lung is removed, a flexible chest tube the size of your pinky finger is inserted to drain any fluid or air after surgery.

The chest cavity is inspected, and any remaining lung is re-inflated. Then, the surgical team closes the wounds with dissolving stitches and a liquid-plastic dressing. The entire surgery takes about two to four hours.

What Should I Expect After Robotic Surgery?

The typical hospital stay is three to five days following your surgery, a period that is critical for preventing blood clots and pneumonia. During this time, the medical team will monitor your recovery, administer pain management and remove your chest tube.

When you first wake up in the Intensive Care Unit, you’re likely to be surrounded by tubes and wires, which can be frightening or confusing. However, you will have a specialized team of nurses, respiratory therapists and physical therapists trained in the care of lung cancer, esophageal cancer, mesothelioma and thoracic surgery patients taking care of you.

Pain Management

Pain control will be managed with the epidural catheter along with medicine through intravenous lines in your arm or hand. Pain medications may make you feel nauseous, in which case the medical team will provide anti-nausea drugs.

Before you are discharged, you must be able to walk comfortably without extra oxygen and be using oral pills for pain control instead of IV medication.

Patient Monitoring

In addition to IV lines in your hand or arm for medication administration, you may also notice other tubes and wires around you. These may be heart monitor wires, a continuous arterial blood pressure monitor in your wrist, a chest tube that is connected to a suction box and a Foley catheter to empty your bladder.

These are all different methods of monitoring your recovery and reducing your risk after surgery. During the first couple of days after surgery, your medical team will begin to remove them. In some cases, the chest tube must remain in place a little longer as the lung tissue heals.

Preventing Blood Clots

While in the hospital, and once you go home, it is essential to walk and perform breathing exercises that prevent pneumonia and blood clots. Walking and breathing exercises are important to start the same day of your surgery as the possible consequences of not doing so, such as pulmonary embolism, are potentially life-threatening.

A specialized team of nurses, respiratory and physical therapists will help you with these breathing exercises using something called an incentive spirometer. The exercises start within a few hours after your surgery. You are usually out of bed to a chair on the same day as surgery and walking the next morning.

Chest Tube Removal

Your medical team will remove your chest tube once your lung tissue has healed and is no longer leaking air, usually one to two days after surgery. You will have a small stitch remaining where the tube was removed. You may remove the dressing over this stitch and shower the next morning. Your doctor will remove the stitch at your follow-up appointment.

If the lung tissue takes longer to heal, the chest tube must remain in place for another few days, up to two weeks. You do not need to stay in the hospital during this period. Instead, you may choose to go home with a valve called a Pneumostat, and a nurse will visit you at home daily to inspect the tube and change the dressing. At your follow-up visit, the surgeon will remove the chest tube in the office.

What Should I Expect When I Leave the Hospital?

After discharge, you’ll have the option of at-home nursing services or referral to a rehab facility at Moffitt’s University of South Florida campus or others within Central Florida.

Rehab is often the best choice if you need physical therapy to improve strength before going home. Unlike a nursing home, rehab is similar to a gym environment and is only temporary. It should be considered an essential part of your recovery, if necessary.

When you are ready to go home or to a rehab facility, it is vital to continue walking and performing light exercise three times per day. You should also continue to use the incentive spirometer for breathing exercises throughout the day. You may resume your regular diet once you leave the hospital.

You will have a prescription for pain control, either Vicodin or Percocet, but it is useful to take an anti-inflammatory such as Motrin or Ibuprofen as well. If you feel nauseous, you may need to cut down on the Vicodin or Percocet. You may also need to take laxatives or stool softeners since constipation is a side effect of pain medications.

If you are discharged home with a wound dressing you may remove it the next day. You should shower daily but avoid baths or swimming pools until your follow-up with your surgeon. If you are on blood thinners, such as Coumadin (warfarin) or Plavix (clopidogrel), you may resume these as instructed by your surgeon’s team.

What Are Some Things I Should Look Out For?

Some pain is normal after surgery but can get worse as you resume activities. While everyone has different pain tolerance levels, you should contact your medical team if anything feels out of the ordinary.

Each patient weans themselves from pain medication differently, so pay attention to how your body responds to regular activity and continue taking pain medication as long as necessary.

If you feel nauseous, you may need to reduce the dosage of Vicodin or Percocet. Pain medication often leads to constipation, but over-the-counter stool softeners can help. Coughing up phlegm and small amounts of blood is also normal and usually resolves on its own within a few days.

Contact your surgeon’s team if you have any of the following:

• A temperature over 101 F or 38 C
• Significant redness or thick discharge from your wounds
• Worsening shortness of breath
• Increased swelling or puffiness around the chest, neck or surgical wounds

Esophageal cancer, lung cancer and mesothelioma patients should contact their doctor if they experience any abnormal or worsening signs or symptoms.

When Can I Resume Activities?

You should return to your routine and daily activities only when you are comfortable and feel ready. Pay particular attention to your pain levels and how your body reacts. Everyone’s recovery is different, so listen to your own body and be logical. You may be able to resume some activities immediately after surgery; more intense outings should wait for many weeks after recovery.

With each activity you resume, go slowly and carefully at first. Always stop if you have pain, shortness of breath or exhaustion. Patients who undergo open surgery with a longer, traditional incision may take more time to resume regular activities due to having more pain or extended recovery time.

Returning to work depends on your occupation and expected duties. In most cases, you should be able to return to work within four weeks. This period may be longer if you have open surgery or if your job requires physical exertion.

The following is a list of average times you can expect to resume typical activities:

• Immediately: You may immediately resume walking, climbing stairs, showering, walking around the block, riding in a car as a passenger and having visitors. You must walk daily.
• Two Weeks: After two weeks you may lift more than 10 pounds, go grocery shopping and resume air travel.
• Two to Four Weeks: Between two and four weeks you may drive, garden and mow the lawn on a riding mower only. Resume each activity at a slow pace, and stop if you feel pain, shortness of breath or exhaustion. Contact your doctor if you notice anything out of the ordinary.
• Four to Six Weeks: Within four to six weeks after your surgery you may lift more than 20 pounds, go golfing, swimming, use a push lawnmower and return to work.

When Do I Return for Follow-Up?

Your surgeon will schedule your follow-up appointment for about a week to 10 days after discharge. At this appointment, the surgical team will remove your suture stitch and discuss the next steps in your care.

The surgeon will likely obtain a chest X-ray during your follow-up appointment as well. This is also an excellent time to ask any questions about activity restriction, returning to work or abnormal symptoms you may have experienced.