Thoracic Surgery

Thorax is the part of the body between the neck and tummy. The surgeries of this cavity are performed by thoracic surgeons also known as Chest Surgeons. Thoracic surgeons are medical doctors trained to operate Esophagus, Trachea (windpipe), Diaphragm, Chest wall (ribs, breastbone and surrounding muscles) and Mediastinum (area between the lungs). Even though the heart is in thorax, its surgeries are performed by cardiovascular surgeons.

Thoracic surgeons can perform thoracic surgery operations with an open or minimally invasive procedure. While a large chest incision is often required in open surgical operations, in operations involving minimally invasive surgical techniques, smaller incisions and camera methods can be used to enter the chest and perform the operation. As a result of advanced technology and extensive research, thoracic surgeons can perform many operations with fewer complications with video cameras they send through the chest wall through tiny incisions. Such operations are known as video-assisted thoracic surgery (VATS) on the chest or laparoscopic surgeries on the abdomen.

 

What Is Thoracic Surgery?

Thoracic surgery involves identifying and rectifying the issues with a specific organ in your chest. It is done to treat and diagnose diseases like cancers in the esophagus and lungs. It can also be performed to repair and reconstruct the chest wall to remove excess fluid around the lungs. Chest surgeries are comprehensive and serious surgeries. The heart and lungs are very important organs and loss of function can have life-threatening consequences. In some cases, complicated surgeries may be required to resolve more than one heart or lung problem. In a minority of cases, a minimally invasive lung surgery can produce effective results.

There are multiple ways in which thoracic surgery can be done, open surgery, laparoscopic and robot-assisted. 

• Open surgery: In this kind of surgery, the surgeon cuts through the skin and underlying tissues of the chest. They use specialized instruments like rib expanders to get to the organs inside the chest. The recovery time is generally higher for open chest surgery.
• Laparoscopic surgery: A minor incision is made to send a thin tube with a camera for viewing inside the chest. It is a minimally invasive surgery, unlike open surgery, and it uses a camera to access and view inside the chest to monitor, analyze and operate on the patient. It involves using special forceps and scissors to perform the surgery. Since the chest is not opened to perform the surgery, it results in lesser pain and scarring and shortens the patient's recovery. It is also called VATS (video-assisted thoracic surgery).
• Robot-assisted surgery: This is an advanced version of laparoscopic surgery. The surgeon sits at the console near the patient and carefully operates on the patient while a thin laparoscope sends him the feed inside the chest. The robot has the tools and instruments needed to perform the surgery. While not all surgeries can be done this way, it is an excellent upgrade for doctors to go one more layer deeper.

 

Thoracic Surgeons: What Do They Do?

Thoracic surgery consists of various surgeries performed to treat a problem located in the chest or upper abdomen. Coronary artery bypass grafting (CABG) and lobectomy are the most common chest surgeries. Major thoracic surgery procedures can be summarized as follows.

• Lung cancer: involves identifying tumor and cancer tissue. Depending on the extent of the cancer's spread, the doctor may remove the part near the lymph nodes or the entire lung.
• Tumors located in the esophagus or originating from the thymus gland: It involves repairing or removing the esophagus or thymus due to the spread of cancer and tissue damage.
• Lung resection surgeries such as pneumonectomy or lobectomy: Pneumonectomy involves the complete removal of one lung from the chest. This surgery prevents the cancer from spreading to other parts of the body. There are complications and risks such as atrial fibrillation, pneumonia, and vocal cord paralysis. Lobectomy is a surgical procedure that involves removing a lobe from the lung. Depending on where the problem is, a lobe may be removed to stop the spread of the disease.
• Chest wall anomalies such as pectus excavatum, pectus carinatum: It is an open surgery to reconstruct the skeletal structure of the chest wall after removing a tumor or infection or repairing chest wall anomalies.
• Thoracentesis: It is the removal of fluid from your chest wall around your lungs using a needle and syringe.
• Pleural effusion surgery: involves removing excess fluid and restricting infection growth from the area around the lungs.
• Enlarged arteries or veins (aneurysms)
• Lung transplant surgeries

 

In high-risk surgeries such as thoracic surgery, some serious complications are also possible. The main risks are as follows.

• Infections, especially pneumonia
• Lung collapse
• Embolism
• Depression
• Irregular heart rhythms
• Heart failure
• Pulmonary edema

 

What Is a Lung Resection?

Lung resection is used to describe surgical operations in which all or part of the lung is removed. Lung resection surgeries are typically planned to treat a lung infection or disease, such as a tumor, cancer, emphysema, or bronchiectasis. Lung resection can be performed with different methods. The applied methods are mainly as follows. Minimally invasive (through small incisions 2-3 inches long under general anesthesia) or open surgery (with large incisions 8-10 inches long under general anesthesia). There are three main types of lung resection. These can be summarized as follows.

• Wedge resection: In the wedge resection procedure, the tissue around the tumor along with the lung cancer tissue is removed by cutting in a wedge shape. This procedure removes less lung tissue than a lobectomy.
• Lobectomy: The most common type of lung resection is lobectomy. In this procedure, one or more lobes of the lungs are removed. In the lobectomy procedure, one of the lobes that may be damaged due to disease or infection is removed. Lobectomy is generally the main preferred treatment procedure in cases such as early-stage lung cancer, tuberculosis, emphysema, bronchiectasis, benign non-cancerous tumors and fungal infections.
• Pneumonectomy: In this type of resection, all lung tissue is removed for cancer, trauma, infection, or other reasons.

 

When to Visit the Doctor

Many different procedures are of interest to thoracic surgeons, including removing cancerous tissue and organs, repairing damaged vessels, muscles, esophagus or trachea, or placing a chest tube to drain fluid that has accumulated in the pleural cavity. There may be some situations that require a thoracic surgeon examination or opinion. In such cases, not being late can have positive results in the disease and recovery process with early diagnosis and treatment. The main signs to watch out for are as follows.

• Persistent cough or chest pain: Cough or chest pain lasting more than a few weeks may be a sign of a problem in the chest that may need to be evaluated by a thoracic surgeon.
• Shortness of breath: Difficulty in breathing or feeling short of breath, especially with physical activity, may be a sign of a problem in the chest that may need to be evaluated by a thoracic surgeon.
• Swelling in the neck or face: Swelling in the neck or face may be a sign of a problem with the vessels, lymph nodes, heart, lungs, or other structures in the chest.
• Weight loss: Unexpected and unintended weight loss can be a sign of diseases such as lung cancer.
• Blood in phlegm: Coughing up blood may be associated with various lung pathologies and requires further evaluation.

 

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