Thoracic surgery is the treatment and study of diseases of the chest or thorax, including lungs, heart, blood vessels and chest wall that require surgical operation for diagnosis and/or treatment. Other organs on which thoracic surgery is performed include, trachea, esophagus, mediastinum and diaphragm. Thoracic surgeons may include congenital heart, cardiovascular and cardiothoracic surgeons. The most common diseases requiring thoracic surgery include lung cancer, chest trauma, esophageal cancer, emphysema, and lung transplantation.
Preparation for Thoracic Surgery
- Except in the case of emergency procedures, candidates for general thoracic surgery should undergo a complete medical history and thorough physical examination prior to surgery
- Particular attention is given to the respiratory system
- The patient’s smoking history will be questioned. If the patient is an active smoker, encouragement is always given for the patient to quit smoking prior to the surgery to facilitate recovery and reduce chances of complications
- Diagnostic tests used to evaluate the patient preoperatively may include, but are not limited to, x rays, MRI, CT scans, blood gas analysis, pulmonary function tests, electrocardiography, endoscopy, pulmonary angiography, and sputum culture
- Patients are instructed not to eat 10 to 12 hours prior to a thoracic surgery procedure
Thoracic Surgery Procedures –
Thoracic Surgical and diagnostic procedures include:
- VATS Lobectomy
- Thoracoscopic lung resection
- Thoracoscopic evaluation and management of pleural space
- Thoracoscopic mediastinal biopsy
- Thoracoscopic resection of mediastinal masses
- Thoracoscopic Staging
The surgeon may use two common incisional approaches: sternotomy (incision through and down the breastbone) or via the side of the chest (thoracotomy). An operative procedure known as video assisted thoracoscopic surgery (VATS) is minimally invasive. During VATS, a lung is collapsed and the thoracoscope and surgical instruments are inserted into the thorax through any of three to four small incisions in the chest wall. Another approach involves the use of a mediastinoscope or bronchoscope to visualize the internal anatomical structures during thoracic surgery or diagnostic procedures.
Types of Thoracic Surgery
The most basic and generalized type, general thoracic surgery involves the treatment of lung diseases, tumors, cancers, and transplants as well as esophageal problems and gastroesophageal reflux.
- Mesothelioma – Mesothelioma is a rare form of cancer that develops from the protective lining that covers many of the internal organs like liver, lung, etc. It is diagnosed with the help of Thoracoscopy besides other evaluation methods. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples . Alternatively, the chest surgeon might directly open the chest (thoracotomy).
- Lung Transplantation – There are various types of lung transplantations: unilateral (one lung; most common type); bilateral (both lungs); heart-lung; and living donor lobe transplantation. Thoracic surgery plays a significant role in lung transplantation.
- Chest Trauma – Chest trauma is a medical/surgical emergency. Patients with respiratory distress require endotracheal intubation (passing a plastic tube from the mouth to the windpipe) and mechanically assisted ventilator support. Invasive thoracic procedures are necessary in emergency situations. Trauma requiring urgent thoracic surgery may include any of the following problems: a large clotted hemothorax, massive air leak, esophageal injury, valvular cardiac injury, proven damage to blood vessels in the heart, or chest wall defect.
- Esophageal Cancer – Over 90% of patients with esophageal squamous cell carcinoma develop the tumor in the upper and middle thoracic esophagus. The standard operation for patients with resectable esophageal carcinoma includes removal of the tumor from the esophagus, a portion of the stomach, and the lymph nodes (within the cancerous region). These tumors are removed by the surgeons through thoracic surgery.
- Soft Tissue Sarcoma – Thoracic surgery is also needed to cure soft tissue sarcoma.Though these tumors can form in any part of the body but they are more common in the arms, abdomen, legs and trunks
- Emphysema – LVRS or Lung volume reduction surgery is the term used to describe surgery for patients with emphysema. Surgery will assist the patient, but the primary pathogenic process that caused the emphysema is permanent because lung tissues lose the capability of elastic recoil during normal breathing.
- Lung Cancer – Lung surgery for cancer includes the removal of the tumor, lymph nodes and sections of the lung that contain the tumor. Thoracic Surgery is the treatment of choice in several types and stages of lung cancer, either alone, or in combination with chemotherapy or radiation therapy. Surgical approach includes Thoracoscopy (VATS-Video Assisted Thoracic Surgery). If the tumor is not accessible with the thoracoscope Thoracotomy is used.