Depending on the reason for your surgery, your doctor may do the following:

• Physical exam
• Blood tests and urine tests
• Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
• Pulmonary function test —a test to assess lung function
• Upper GI series —x-ray of the esophagus, stomach, and part of the small intestines after swallowing a barium solution
• Electrocardiogram (ECG, EKG) —a test that records the electrical currents passing through the heart muscle
• Ultrasound —a test that uses sound waves to visualize the inside of the chest
• CT scan —a type of x-ray that uses a computer to create images of structures inside the chest
• MRI scan —a test that uses powerful magnets and radiowaves to create images of structures inside the chest
• Upper endoscopy —a lighted tube equipped with a camera is used to visualize the inside of the esophagus, stomach, and part of the small intestines

Leading up to the procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
  • Anti-inflammatory drugs (eg, aspirin )
  • Blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin)
• Take antibiotics if instructed.
• Follow a special diet if instructed.
• Take a laxative and/or use an enema to clean out your intestines if instructed.
• Shower the night before using antibacterial soap if instructed.
• Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
• Eat a light meal the night before. Do not eat or drink anything after midnight.

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

You will be connected to a ventilator. This is a machine that moves air in and out of your lungs. Next, the doctor will cut several keyhole openings in the chest wall between the ribs. One or more chest tubes may be placed into the side of the chest. These tubes will be used to drain fluid and monitor air leakage. A needle may be used to inject carbon dioxide gas into the chest cavity. The gas will make it easier for the doctor to see internal structures.

The doctor will then pass a small camera, called an endoscope, through one of the incisions. The camera will light, magnify, and project the structures onto a video screen. The camera will be attached to one of the robotic arms. The other arms will hold instruments for grasping, cutting, dissecting, and suturing. These may include:

• Forceps
• Scissors
• Dissectors
• Scalpels

While sitting at a console near the operating table, the doctor will look through lenses at magnified 3D images of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. With joystick-like controls and foot pedals, the doctor will guide the robotic arms and tools to remove organs and tissue. After the tools are removed, the doctor will use sutures or staples to close the surgical area.

If you are doing well, the breathing tube will be removed. Later, the chest tubes will be removed.

About 1-4 hours (depending on the procedure)

You will have pain during recovery. Your doctor will give you pain medicine. You may also feel discomfort from the gas used during the procedure. This can last up to three days.

This procedure is done in a hospital setting. The usual length of stay is a few days. Your doctor may choose to keep you longer if you have any problems.