The surgical treatment of conditions affecting the organs and structures inside the chest (thorax), including the lungs, esophagus, trachea, chest wall, diaphragm, anterior and posterior mediastinum, and pleura (the small space-envelope between the lung and chest), falls under the category of thoracic surgery. However, it does NOT include procedures involving the heart.
Lung resections (lobectomy, pneumonectomy, segmentectomy, wedge resections, sleeve resections), tracheal resection/repair, thymectomy, anterior and posterior mediastinal tumor removal, decortications, chest wall resection, and diaphragm repairs are a few frequent thoracic surgery treatments.
Thoracic surgeons carry out the treatments using various methods, including minimally invasive surgery such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS).
The goal of thoracic surgery is to diagnose and surgically treat conditions that affect the chest and lungs while minimizing the risk of complications and maximizing the chances of a successful outcome.
Who does Thoracic Surgery?
A thoracic surgeon is a doctor with training who specializes in the diagnosis, treatment, and surgery of diseases of the lungs, trachea, chest wall, diaphragm, pleural-based disorders, and esophagus that affect the chest and thorax.
A pure thoracic surgeon is different from a traditional cardio-thoracic surgeon in that he or she only performs surgery on disorders that are intrathoracic (located inside the chest), not the heart.
Thoracic surgeons strive to give their patients the finest treatment while minimizing risks and increasing the likelihood of favorable results. They are responsible for making diagnoses, coming up with treatment plans, performing procedures, keeping track of patients' recovery, working with other healthcare professionals, notably pulmonologists (doctors who specialize in lung disorders), and staying up to date on developments in the industry. Thoracic surgeons may work in various hospitals, education, and research. Although the work requires a high degree of technical expertise, knowledge, and judgment, it is a fulfilling industry essential to aiding patients in recovering from chest and lung problems.
Lung Cancer Surgery
In the modern world, lung cancer is the most common type of cancer to harm people. However, because it is "silent," it frequently advances before the patient experiences symptoms. Depending on the stage of the disease, the aim of lung cancer surgery is to remove the malignant tissue as well as different portions of the lung. In addition to alleviating the symptoms, it may also be treatable. The choice to have lung cancer surgery depends on the patient's general health, the stage of the disease, and the patient's lung function. Lung cancer surgery is a complicated treatment.
Tuberculosis and Infectious Diseases
In our nation, tuberculosis (TB) is an endemic illness. Surgery for tuberculosis is often required when medical treatment has failed or when the illness has seriously damaged the lungs, chest wall, or other organs, sometimes resulting in secondary consequences such hemoptysis (coughing up blood) and recurrent infections. The intensity and location of the TB infection, as well as the patient's general condition, will determine the precise sort of surgery that is carried out.
A few frequent TB surgical treatments include:
Lung Resection: This procedure removes a piece of the lung that has been damaged by TB (or its sequelae), such as damaged lung tissue, cavitary illness, or bronchiectasis. A minimally invasive (thoracoscopic) method or a conventional "open" approach can both be used to achieve this.
Decortication: In this treatment, the thin membrane known as the pleura—which borders the chest cavity and covers the lungs—is freed from the sick, thicker, and adhering layer that has been "trapping" it. It frequently occurs in infectious situations, particularly pleural TB, and causes discomfort and respiratory problems.
"Window" thoracostomy: This operation includes opening a tiny hole in the chest wall to let infected fluid (Empyema) escape from the pleural cavity and to stop abnormally high air pressure in the chest from impairing the ability of the lungs to expand.
Pleural biopsy: During this technique, a tiny sample of pleura tissue is removed for examination. When more testing is required and the diagnosis of TB is uncertain, a pleural biopsy is done.
Pneumothorax: An air-filled pleural cavity that compresses the lungs and makes breathing difficult.
Pleural effusion: An abnormal buildup of fluid in the pleural cavity (the area around the lungs) that results in symptoms including fever, coughing, trouble breathing, etc.
Empyema: A buildup of infected fluid in the pleural cavity that can cause the pleural membrane to thicken and the lung to become "trapped."
Chylothorax: An accumulation of "fatty" fluid in the pleural cavity that impairs breathing and is aggravated by dietary issues
Pleural deposits/mass: They can result in chest discomfort, coughing, trouble breathing, or deposits from an advanced tumour that is far away.
Airway - Trachea & Bronchi
The airways are the flexible tubes that transport air to and from the lungs so that oxygen and carbon dioxide may be exchanged. Tracheal and major (larger) bronchial disorders can be quite debilitating.
Tracheal stenosis: A constriction of the trachea that can lead to stridor or breathing problems. The trachea can be surgically opened up to increase ventilation.
Tracheomalacia: is a weakening of the tracheal wall, which can lead to an obstruction of the airway and breathing difficulties. It is possible to conduct airway surgery to support the trachea and enhance breathing.
Bronchomalacia: A weakening of the bronchial walls that can lead to an airway collapse and breathing difficulties. It is possible to undergo airway surgery to support the bronchial tubes and enhance breathing.
Subglottic stenosis: is a constriction of the larynx below the voice cords, which can make breathing difficult. To enlarge the airway and enhance breathing, airway surgery can be done.
Tracheal neoplasms: can produce obstructive symptoms like stridor or breathing problems and often manifest as masses or nodules. The condition may be cured and its symptoms will be relieved by complete excision as well as a portion of the trachea.
Chest Wall Diseases
Congenital disorders: Pectus excavatum and Pectus carinatum, very uncommon chest wall abnormalities that can affect breathing mechanics and appearance.
Primary chest wall tumours: These include tumours arising from bone (osteoblastoma, osteosarcoma, etc.), cartilage (chondrosarcoma, chondroblastoma, etc.), and a number of different tumours (fibrous dysplasia), muscle, and other connective tissue.
Secondary tumours: These are metastases from other sites, or tumours that start elsewhere in the body and spread to the chest wall.
Thoracic outlet syndrome (TOS): This term refers to a series of illnesses that can develop when the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest are compressed, damaged, or irritated. While it can affect people of any age or gender, athletes and persons with bad posture are more likely to develop TOS than the general population. The indications and symptoms of TOS include neck, shoulder, and arm discomfort as well as numbness or reduced circulation to the afflicted areas.
Chest Wall Diseases
Complex Pneumothorax: Traumatic chest wounds can result in "Tension" or Open Pneumothorax (sucking chest wounds), which can be instantly life-threatening issues as a result of air pressure building up inside the chest cavity. They frequently need emergency care in the form of a tube thoracostomy.
Hemothorax: When blood builds up in the chest cavity and compresses the lungs, it might result in clot development and infection (empyema).
Chest wall injury: Traumatic chest injuries can manifest as sternal fractures, flail chest, displaced rib fractures, and unstable chest walls.
Diaphragmatic injuries: Rips or ruptures can result from direct trauma or an abrupt rise in intra-abdominal pressure.