Discover Our Minimally Invasive Thoracic Surgery Program

“Our thoracic surgery program is dedicated to providing advanced, compassionate care to patients with diseases of the chest, including the lungs, esophagus, mediastinum, chest wall and diaphragm,” explains Dr. Chmielewski. “Our team includes board-certified thoracic surgeons, pulmonologists, oncologists, radiologists, advanced practice providers and specialized nursing staff who collaborate to deliver personalized treatment plans.”

The Minimally Invasive Thoracic Surgery Program at the AdventHealth Heart, Lung and Vascular Institute is a high-volume center with dedicated expertise in robotic and video-assisted thoracoscopic surgery (VATS), enabling us to offer minimally invasive options to a range of patients. We have specific thoracic surgery operating suites with state-of-the-art robotic platforms, which allow our multidisciplinary team of surgeons, oncologists, radiation therapists and pulmonary experts to coordinate seamlessly for the care you deserve.

“Thoracic conditions are often managed through a combination of approaches, and surgery is just one part of a broader treatment plan,” shared Dr. Chmielewski. “Nonsurgical treatment options include chemotherapy, immunotherapy, radiation therapy, pulmonary rehabilitation and medical management.”

Beyond minimally invasive thoracic surgery, other surgical treatment options include:

• Chest wall reconstruction: for tumors or traumatic injuries involving the ribs or sternum
• Esophagectomy: removal of part or all of the esophagus for cancer, achalasia or benign end-stage esophageal disease
• Lung transplantation: for end-stage lung disease, such as severe COPD or pulmonary fibrosis
• Open thoracotomy: still used in select complex cases requiring maximum exposure

Our program uses these leading-edge treatments to care for a wide range of thoracic conditions.

“Thoracic surgeons are trained to diagnose and treat a wide range of diseases affecting the organs and structures within the chest,” says Dr. Chmielewski. “Our program treats many thoracic conditions affecting the lungs, esophagus and mediastinum.”

Lung Conditions We Treat

Lung conditions we treat include:

• Benign lung tumors and cysts
• Emphysema and severe COPD (lung volume reduction surgery)
• Lung cancer (non-small cell and small cell)
• Lung infections (abscess, fungal infections or cavitary disease)
• Pulmonary nodules (suspicious spots requiring biopsy or removal)
• Pneumothorax (collapsed lung)

Esophageal Conditions We Treat

Esophageal conditions we treat include:

• Achalasia (difficulty swallowing due to impaired muscle function)
• Esophageal cancer
• Esophageal diverticula
• Gastroesophageal reflux disease (GERD) and anti-reflux procedures

Mediastinum and Chest Wall Conditions We Treat

Mediastinum and chest wall conditions we treat include:

• Chest wall tumors and deformities
• Diaphragm disorders
• Hyperhidrosis (excessive sweating; treated via sympathectomy)
• Mediastinal tumors and cysts
• Myasthenia gravis (thymectomy)
• Pleural disease (mesothelioma, empyema, recurrent pleural effusions)
• Thoracic Outlet Syndrome (TOS)
• Thymoma and thymic cancer

Minimally invasive thoracic surgery offers the greatest precision and the highest success rates for the conditions we treat.

“Minimally invasive thoracic surgery (MITS) refers to surgical techniques that access the chest cavity through small incisions — typically 0.5 to 1.5 centimeters — rather than the large chest-opening incision (thoracotomy) used in traditional open surgery,” explains Dr. Chmielewski.

How It’s Performed

The two primary approaches to MITS are:

• Robotic-Assisted Thoracic Surgery (RTS): Your surgeon operates from a console, controlling robotic arms that hold the camera and surgical tools. The robotic system provides 3D magnified visualization, tremor filtration and a greater range of motion than the human wrist, enhancing precision in confined spaces such as the chest.
• Video-Assisted Thoracoscopic Surgery (VATS): Your surgeon inserts a tiny camera (thoracoscope) and specialized instruments through small incisions between your ribs. The camera transmits high-definition images to a monitor, guiding your surgeon throughout the procedure.

Rest assured, both procedures are highly effective at treating various thoracic conditions and cause significantly less trauma to surrounding tissues than open surgery.

"Most patients requiring thoracic surgery are potential candidates for a minimally invasive approach," says Dr. Chmielewski. "A thorough preoperative evaluation helps determine the best technique for each patient." Ideal candidates for MITS generally include:

• Individuals with hyperhidrosis requiring sympathectomy
• Individuals with pulmonary nodules that need diagnostic removal or biopsy
• Patients with early to intermediate stage lung cancer (Stage I–IIIA) requiring lobectomy or segmentectomy
• Patients with esophageal conditions, including achalasia or early-stage esophageal cancer
• Patients with mediastinal tumors, thymoma or myasthenia gravis requiring thymectomy
• Patients with spontaneous or recurrent pneumothorax
• Those with recurrent or symptomatic pleural effusions requiring drainage and pleurodesis

“It's important to note that certain factors may affect candidacy, including prior chest surgery, severe adhesions, active infection or tumors involving major blood vessels,” shares Dr. Chmielewski. However, even patients previously considered poor candidates for minimally invasive surgery can often benefit from robotic techniques due to their enhanced visualization and precision.

“Recovery varies based on the type and extent of surgery, the patient's overall health and the underlying condition being treated,” says Dr. Chmielewski. Most patients remain in the hospital after surgery for one to three days and can return to light activity within one to two weeks. A full recovery typically takes four to eight weeks, and patients can return to desk-based or sedentary work around four weeks post-surgery.

“Similarly, success is measured differently depending on the condition being treated,” states Dr. Chmielewski.

• Conversion to open surgery: Robotic- and video-assisted procedures are converted to open thoracotomy in fewer than 5% of cases
• Early-stage lung cancer (Stage I): Five-year survival rates of 80 to 92% following complete surgical resection
• Esophageal achalasia (Heller myotomy): Over 90% of patients experience significant long-term relief of swallowing difficulty
• Para-esophageal hernia repair and anti-reflux procedures: Strive for 90% control of symptoms, off medications and recurrence rates less than 10%
• Pneumothorax repair: Recurrence rates of less than 5% following VATS pleurodesis or pleurectomy
• Thymectomy for myasthenia gravis: Approximately 30 to 50% of patients achieve complete stable remission; the majority experience meaningful symptom improvement

Minimally invasive approaches offer significant advantages compared to traditional open chest surgery, making it the most patient-preferred option.

“Evidence from large clinical studies consistently shows many patient benefits,” states Dr. Chmielewski. These benefits include:

• Better cosmetic outcomes: Small port-site scars are far less visible than a traditional thoracotomy incision
• Comparable or superior oncologic outcomes: For lung cancer surgery, VATS and robotic resections achieve equivalent or better lymph node staging and long-term survival compared to open surgery
• Faster return to normal activity: Patients typically resume light activities within one to two weeks
• Less pain: Smaller incisions cause less trauma to muscles, nerves and ribs
• Lower infection risk: Smaller wounds are less prone to surgical site infections
• Preservation of lung function: Less surgical trauma helps patients maintain better respiratory capacity after surgery
• Reduced blood loss: Greater accuracy reduces the risk of bleeding during the procedure and the need for a blood transfusion

Our expert physicians in our thoracic surgery program are committed to helping you heal in the safest way possible and will work with you to determine if minimally invasive thoracic surgery is right for you.