Thoracic Surgery

About Thoracic Surgery

General Thoracic Surgery

The general thoracic service provides expansive and comprehensive services for the surgical treatment of non-cardiac benign and malignant diseases of the chest, including the lungs, esophagus, chest wall, airway, mediastinum (the central compartment of the chest) and diaphragm. Many of our therapies are performed using minimally invasive techniques such as video-assisted thoracic surgery or VATS and laparoscopic surgery.

 

Problems of the lung and airway affect normal respiratory functioning, making breathing difficult. They may be caused by an underlying illness, an injury or infection, or be the side-effect of cancer treatment.

 

The Division of Thoracic Surgery at Al Zahra Hospital Dubai offers comprehensive testing and advanced treatment for patients with diseases and conditions of the lung and airway, from more routine conditions to rare and complex diseases. We treat chronic obstructive pulmonary disease (COPD), tracheomalacia and emphysema, empyema and pleural effusion, pneumothorax/collapsed lung and also specialize in tracheal and bronchial disorders, benign or cancerous.

Our General Thoracic Surgery Services at Al Zahra Hospital Dubai include:

1. Airway & Tracheal Disorders

The trachea, known as the airway or windpipe, is a tube that starts under the larynx (voice box) and runs behind the breastbone. It then divides into two smaller tubes, (bronchi) which lead to the lungs. When breathing, a normal trachea widens and lengthens with each breath. Inflammation can cause scarring and narrowing of the trachea, while birth defects or injury can cause the trachea to become soft and floppy. Tumors can also cause blockage of the trachea or the main bronchi. All of these conditions can severely affect your breathing.

The main types of tracheal disorders include :

Tracheal stenosis is a narrowing of the trachea, or “windpipe,” that prevents air from fully reaching the lungs. The effects of this narrowing can range in severity from mild to more severe. In the most severe

Tracheal tumors include:

✔ Benign: pleomorphic adenoma, squamous cell papilloma, chondroma, granular cell tumor, glomus tumor, neurofibroma

✔ Malignant: adenoid cystic carcinoma, squamous cell carcinoma, malignant epithelial tumor, carcinoid tumor, mucoepidermoid carcinoma, small cell and non-small cells lung cancer.

 

Diagnosing Tracheal Conditions:

After taking your medical history and performing a careful physical examination, The Lung Center team may perform the following procedures to confirm a diagnosis of tracheal stenosis or tracheomalacia:

6-minute walk test measures the distance an individual can walk over a period of 6 minutes on a hard, flat surface to determine functional exercise capacity.
Advanced cardiopulmonary exercise testing uses catheters during exercise (treadmill or stationary cycling) to measure heart and lung function.
Bronchoscopy uses a bronchoscope to examine the inside of the trachea, bronchi (air passages that lead to the lungs). It allows for precise diagnosis of the problem and measurement of the area affected to determine the best possible therapy options.
CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat and organs.
Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media.
Dynamic 3D chest CT scan takes a closer look at the area while the patient inhales and exhales to outline the structures for surgical planning.
Laryngoscopy allows your doctor to examine the back of your throat, larynx and vocal cords using a scope (laryngoscope).
Magnetic resonance imaging (MRI) uses strong magnetic fields, radio waves and field gradients to image the anatomy and physiological processes of the body. This procedure provides a non-invasive method of assessing the trachea.
Pulmonary Function Test measures how well the lungs work.
Pulmonary ventilation/perfusion scan involves two nuclear scan tests: injection of radioactive albumin into your veins and breathing radioactive gas through a mask to allow a machine to measure circulation (perfusion) and breathing (ventilation).
Treatment for Tracheal Disorders:

✔ Tracheal Stenosis

✔ Tracheomalacia

✔ Trachial Tumors

✔ Tracheal Stenosis

 

There are several surgical options to treat tracheal stenosis. Your surgeon will recommend the best option for you, based on the cause, location and severity of the narrowing. Possible treatments and procedures are:

Argon plasma coagulation (APC)

Bronchoscopic Tracheal dilation uses a balloon, tracheal dilator or electrocautery to widen the trachea.

Laser bronchoscopy uses lasers to remove scar tissue and proves excellent short-term relief for symptoms.

Tracheobronchial airway stent or T-tube.

 

Tracheal resection and reconstruction, where the scarred and constricted section of the trachea is removed and the upper and lower sections are rejoined. This treatment has excellent long-term results and is the first indicated procedure for certain tumors and stenosis.

Tracheobronchoplasty, a procedure performed at few hospitals across the United States, that involves suturing mesh to the outside of a patient’s trachea through a series of knots, which opens the collapsed tissue in the tracheal wall to create an opening to process air. The goal is that the area will scar over, thereby strengthening the structure and making it permanent.

 

Tracheomalacia

 

Often, tracheomalacia can improve without treatment. However, you should be monitored closely if you suffer from frequent respiratory infections. Treatments may include:

 

Continuous positive airway pressure (CPAP) uses mild pressure to keep the airway open.

Tracheal resection and reconstruction, a surgical method that removes the constricted section of the trachea and rejoins the upper and lower sections.

 

Tracheal Tumors

 

In addition to using some of the surgical procedures listed above, your physician may treat your tumor using some of the following therapies:

 

Brachytherapy involves locally delivered radiation therapy to the airway.

Photodynamic therapy (PDT) uses the light of a specific wavelength to kill cells and damage tumor vasculature, with the goal of inducing an inflammatory reaction that helps to eliminate the tumor.

2. Chest wall

2.1 Chest Wall

 

Diseases of the chest wall and diaphragm may be congenital or acquired. Many are the result of trauma or malignancy.

The Thoracic Surgery services at Al Zahra Hospital Dubai offers comprehensive evaluation and advanced surgical treatment for a range of conditions affecting the chest wall (ribcage), breastbone (sternum) and diaphragm, including congenital issues and those caused by injury or illness.

✔ Chest Wall Cancer

✔ Pectus Malformation

✔ Rib Fractures

 

2.2 Chest Wall Cancer

Comprising less than five percent of all thoracic malignancies, cancers of the chest wall are rare and difficult to treat. Chest wall tumors can develop in the bones, soft tissues and cartilage of the chest cavity, which contains the heart, lungs and other organs. These tumors typically involve invasion or have metastasized from adjacent thoracic tumors and are malignant in more than half of cases.

The most common chest wall cancer is sarcoma of the chest wall, including:

✔ Chondrosarcoma

✔ Osteosarcoma

✔ Ewing’s sarcoma

✔ Fibrosarcoma and malignant fibrous histiocytoma (MFH), leiomyosarcoma

✔ Plasmacytoma

Treatment For Chest Wall Cancers

The purpose of surgery is to remove all visible diseases. We also strive to preserve the function of the chest and arms so patients can continue to enjoy activities important to them, including golf and other sporting activities. Surgical options for chest wall cancer include:

Chest wall resection and reconstruction is the primary surgical option for chest wall tumors. This surgery involves the removal of one or more ribs to extract the tumor, followed by reconstruction to recreate a normal appearance after invasive surgery. This can involve prosthetic materials and/or rotation of muscle flaps.

Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest to remove the tumor.

 

2.3 Pectus Malformation

The pectus, or chest wall, is made up of bone and muscle covered by skin. It protects vital organs such as the heart, lungs and great vessels from injury, as well as aids the breathing process. Malformations can occur in the ribs and sternum of the chest wall, in which the sternum is abnormally sunken (pectus excavatum) or abnormally prominent (pectus carinatum). Pectus excavatum tends to be an inherited condition affecting males. Pectus carinatum may occur as a singular abnormality or in association with other genetic syndromes. Pectus malformations can have significant medical and psychological impact.

Treatment for Pectus Malformation

For many patients with pectus excavatum, there are no symptoms other than the sunken appearance of the chest and no treatment is required other than regular checkups with your doctor. For some patients, especially those who are born with this condition, the symptoms slowly develop as they get older and do not cause any problems until adulthood. When the function of the heart or lungs is compromised, or the patient’s breathing or posture is affected, surgery is recommended. Minimally invasive surgical treatments for pectus malformation are:

Highly modified Ravtich technique removes cartilage and elevates the breastbone with two stainless steel struts inserted through a small vertical incision in the mid-chest.

Nuss procedure, a type of VATS (video-assisted thoracic surgery) generally used for adolescent patients. A curved steel bar (known as the Lorenz Pectus Bar) is inserted through two small incisions under the sternum. It pushes out the depression and is then fixed to the ribs on either side.

Pectus Carinatum

Pectus carinatum often does not need treatment. When the condition is severe and causing medical issues or emotional distress, the following treatments are available:

Minimally invasive surgery may be performed to improve the appearance of the chest. Techniques include:

Osteotomy: Small bone cuts in the breastbone smooth out the contour and resolve rotation of the bone.

 

2.4 Rib Fractures

 

Rib fractures are commonly caused by trauma to the chest wall. Extremely painful, rib fractures can represent an isolated injury or be part of a larger multi-system injury. A rib may be fractured in one place, two places (flail), or be shattered.

 

Rib fractures are most caused by blunt injuries to the chest caused by a car accident, fall or assault. Penetrating injuries such as gunshot wounds are a less frequent cause. When severe, rib fractures can lead to flail chest (open chest wound) and cause breathing issues, pulmonary contusion, bleeding, and pneumothorax. When untreated, rib fractures will lead to serious short-term consequences such as severe pain when breathing, pneumonia and, rarely, death. Long-term consequences include chest wall deformity, chronic pain, and decreased lung function.

 

Although most broken ribs heal without surgery, a severely crushed chest with many broken ribs will likely benefit from this new operative technique.

3. Gastroesophageal Reflux, Achlasia and Hiatal Hernia

Gastroesophageal reflux disease (GERD) is a common digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.

 

In normal digestion, food travels from the mouth, through the esophagus and into the stomach. In the stomach, the gastric secretions, which include acid, fluids, and enzymes, break down the food as it moves into the intestines. Normally, following a swallow, the lower esophageal sphincter (LES) relaxes and allows food to pass into the stomach. It then closes to prevent this food from backing up into the stomach. However, for some people, the LES stays relaxed. This allows the acidic contents of the stomach to reflux back into the esophagus and damage the lining.

 

Gastroesophageal reflux disease can be successfully treated most of the time. However, chronic GERD can lead to other problems in the esophagus including inflammation, ulceration, scarring, stricture (narrowing) and precancerous changes (Barrett’s esophagus). In a very small percentage of patients, the changes in the esophagus can lead to esophageal cancer.

Treatment for GERD/Reflux

Treatment Of Hiatal Hernia

Treatment of Achlasia

 

Treatment of GERD/Reflux

 

There are many ways your thoracic surgeons can help you to manage and treat your GERD/reflux. Typical treatment ranges from lifestyle changes to medications. In more serious cases of GERD, surgery is considered. The goal of treatment is to pinpoint the cause of your GERD, so you can make changes to prevent it from recurring.

 

Diet and lifestyle changes can have a huge impact on your GERD symptoms. Actions you can take to relieve your symptoms are:

 

  1. Avoid foods that aggravate your symptoms (as listed above)
  2. Add foods to your diet that tend to improve GERD:
  3. Non-acidic fruits (bananas, apples, Pears)
  4. Foods lower in fat and calories
  5. High fiber foods (whole wheat, oatmeal, brown rice, beans)
  6. Avoid overeating
  7. Lose weight
  8. Stop smoking
  9. Reduce consumption of alcohol and caffeine
  10. Avoid medications that can irritate the lining of your stomach or esophagus (aspirin, ibuprofen)
  11. Wait a few hours after eating to lie down or go to bed
  12. Elevate your head when sleeping – raise the head of your bed by 6-8 inches
  13. Medications may be needed if changes in your lifestyle do not offer enough relief for your symptoms. There are many options for medications, and they can be extremely helpful.

In some cases, patients may need lifelong medication:

    • Over-the-counter oral antacids
    • Over the counter H2 blockers
    • Stronger, prescription-strength antacids
    • Proton pump inhibitors
    • Medications that make your stomach empty faster

 

For some patients who do not get relief from GERD/medications and lifestyle changes, surgery is often advised. The goal of surgery is to fix the anatomy rather than just treating the symptoms of GERD/reflux. Surgery should be considered for patients who:

 

Have not had success with medications

Do not want to take chronic medication

Have complications of GERD (stricture, Barrett’s esophagus; grade III or IV esophagitis)

Have medical complications attributable to a large hiatal hernia (bleeding, dysphagia)

Have atypical symptoms (asthma, hoarseness, cough, chest pain, aspiration) and documented reflux

 

Minimally Invasive Surgery: Nissen fundoplication tightens the lower esophageal sphincter and helps to decrease acid from coming up from the stomach into the esophagus. Fundoplication is usually performed as a laparoscopic procedure.

 

Linx Procedure is a minimally invasive operation that is indicated for a small percentage of patients with GERD and no hernia where a chain is placed around the esophagus to prevent reflux.

 

Transoral Incisionless Fundoplication (TIF), a transoral (through the mouth) procedure in which the EsophyX device is used to wrap around the esophagus and create a fold. This is then repeated several times to create a tight valve to prevent stomach contents from flowing back up into the esophagus.

 

Treatment of Hiatal Hernia

 

A hernia is a protrusion of part of an organ through the muscle wall that surrounds it. A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening (called the hiatus) in the diaphragm, the muscle that separates the abdomen from the chest.

 

Most of the time, a hiatal hernia is small enough not to cause any symptoms and you may never know you have one. However, if your hiatal hernia is large enough, the opening in the diaphragm increases, allowing more of your stomach and sometimes other organs to slide into your chest. Sometimes, the hernia squeezes your stomach, causing restriction and discomfort. The stomach may rotate and twist as well. This results in retention of acid, which can easily back up into your esophagus, causing gastroesophageal reflux disease (GERD), heartburn, chest pain, swallowing problems, and breathing problems.

 

Hernias can often be monitored regularly. However, treatment may be necessary if the hernia is:

 

In danger of becoming strangulated (twisted in a way that cuts off blood supply to the stomach

Complicated by severe gastroesophageal reflux disease (GERD)

Complicated by esophagitis (inflammation of the esophagus)

Causing chronic anemia or a need for blood transfusions

Causing recurrent pneumonia or infection

Causing pain or inability to vomit

 

Treatments may include:

 

Medication to neutralize stomach acid, decrease stomach acid, or improve stomach motility.

Minimally Invasive Surgery

Laparoscopic surgery to reduce the size of the hernia or to prevent strangulation by closing the opening in the diaphragm.

A fundoplication is performed in addition to reducing the hernia to help decrease acid and fluid from coming up from the stomach after the hernia is repaired. Fundoplication is usually performed as a laparoscopic procedure.

Treatment of Achlasia

 

Surgery may be done to open a tight Lower Esophageal Sphincter. This is called myotomy. During myotomy, the muscles of the LES are cut. This procedure can be done using a minimally-invasive approach called laparoscopy. A few small cuts (incisions) are made. A thin, lighted tube called a laparoscope is used. This scope lets the doctor see inside your body and work through the small incisions. At the same time, your surgeon may do a procedure called a fundoplication to help minimize acid reflux (GERD) after the procedure. This is done by wrapping the very top of the stomach around the lower part of the esophagus. This type of surgery often gives long-term relief from achalasia symptoms.

 

4. Esophageal Cancer

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea (wind-pipe), is about 10 to 13 inches in length and carries food from the mouth to the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma and a few rare ones, including melanoma, small cell carcinoma and leiomyosarcoma.

 

Symptoms Of Esophageal Cancer

Diagnosis of Esophageal Cancer

Treatment of Esophageal Cancer

Multidisciplinary Team Care

Symptoms of Esophageal Cancer

People with early stage esophageal cancer usually have minimal symptoms. Symptoms typically do not appear until the disease is more advanced. The most common symptoms are:

Difficult swallowing (dysphagia)

Painful swallowing

Weight loss

Heartburn

Regurgitation of undigested food

Hoarseness or persistent chronic cough

Hiccups that persist

Vomiting

Blood in stools or black-looking stools

Coughing up blood

Anemia

Pneumonia

Pain in mid-chest, throat, back, behind breastbone, between shoulder blades

 

Diagnosis of Esophageal Cancer

 

There is no routine screening examination for esophageal cancer; however, people with Barrett’s esophagus should be examined often (with endoscopy) because they are at greater risk for developing the disease. When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when diagnosed. However, there are treatments to manage and successfully treat all stages of esophageal cancer. Diagnostic tests and procedures include:

 

Physical exam and medical history

Complete blood count

Blood chemistry studies

Chest X-ray

Upper GI (gastrointestinal) series (also called barium swallow) For this series of stomach X-rays of the stomach, patients drink a liquid that contains barium (a silver-white metallic compound). It coats the stomach, and we take X-rays of it. This procedure is also called an upper GI series.

Esophagoscopy (or endoscopy), an esophagoscope, a thin tube with a lighted lens, is inserted, using some sedation, through the mouth or nose and down the throat into the esophagus to look at and if needed remove tissue samples, which are checked under a microscope for cancer. When the esophagus and stomach are looked at in this way, the procedure is called an upper endoscopy.

Endoscopic Ultrasound (EUS) can show how deeply the cancer has invaded the wall of the esophagus and whether cancer has spread to nearby lymph nodes. It helps determine staging (determining how advanced the cancer is) and the next best step for treatment. An endoscope is inserted into the body, usually through the mouth. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

CT-scan and PET Scan

 

 

Treatment of Esophageal Cancer

 

Treatment for esophageal cancer depends on many factors including the stage of the cancer and where it is located. Your thoracic surgeon will discuss the best treatment for your particular situation. Often a combination of therapies will be recommended.

 

Surgery is the most common treatment for esophageal cancer. The goal of surgery is to completely remove the cancer and all surrounding lymph nodes. Surgery is most effective with early disease, but can be used in conjunction with chemotherapy and radiation for advanced cancer. Surgery also provides relief of symptoms such as obstruction and dysphagia (difficulty swallowing).

 

Minimally invasive esophagectomy is the approach of choice that our surgeons used to remove esophageal cancer. This operation has largely replaced at our hospital the open esophagectomy approach that is still used by most other surgeons in this and other countries to treat esophageal cancer. Instead of large incisions and cutting ribs, our surgeons are able to do this operation through small incision using video scopes to guide them. These video thoracoscopic and laparoscopic, and occasionally robotic, techniques allow for fewer complications, less pain and faster recovery.

Photodynamic Therapy (PDT), an endoscope with a laser on the end is used to destroy cancer cells on or near the inner lining of the esophagus. This approach is used to relieve blockage of the esophagus caused by cancer.

 

Esophageal staging and jejunostomy, Not infrequently patients may present with intermediate stage esophageal cancer which is best treated by first shrinking the cancer with chemotherapy and radiation therapy and then taking the remaining cancer out by surgery as described above. Patients who have difficulty eating, may benefit from a minimally invasive video laparoscopy with placement of a feeding tube prior to initiation of therapy so that they can continue to receive nutrition while receiving chemotherapy, and be strong enough to later tolerate the esophagectomy operation.

 

Esophageal stent: To overcome obstruction from tumor, our surgeons will occasionally place a cylindrical stent that crosses the obstruction in the esophagus using an endoscope. This is usually done under anesthesia as an outpatient procedure.

Other surgical procedures:

 

There are a number of ways to remove the esophagus, all of which have been previously developed by an open surgical technique and have been practiced by our surgeons using minimally invasive techniques. They generally refer to how much esophagus is removed and where the incisions are. These are usually related to the location of the tumor.

 

Transhiatal esophagectomy

Three hole esophagectomy

Ivor-Lewis esophagectomy

Thoracoabdominal esophagectomy

Subtotal gastrectomy

Total gastrectomy

In all of these operations, the esophagus is removed and reconstructed by elongating the stomach. In some cases, however, the colon or small bowel may be used as an esophageal replacement. A feeding tube is placed during surgery to provide nutrition until you can eat adequately.

 

Non-surgical cancer treatments

 

Radiation Therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy before surgery to shrink the tumor.

Chemotherapy. Chemotherapy uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases of esophageal cancer. The purpose is to shrink the tumor with the goal of making the tumor small enough that it can be surgically removed. It is often used in conjunction with radiation.

5. Lung Cancer

Lung cancer forms in tissues of the lung, usually in the cells lining air passages. It starts from a single cell, but usually includes millions of cells by the time it can be seen by an X-ray. Cancer cells lose their previous function in the body. Instead they grow faster than regular cells. They cause the body to weaken and prevent organs from working. The two main types of lung cancer are small cell lung cancer, which spreads quickly and non-small cell lung cancer, which is more common and spreads slowly. Treatment depends on the type and stage of lung cancer and may include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy.

 

Diagnosis of lung cancer often includes several different tests and procedures, many conducted by your thoracic surgeon:

 

Medical history

Physical examination

Blood and urine test

Chest X-ray to look for any mass or spot on the lungs.

Computerized tomography scan (CT scan) uses a combination of X-rays and computer technology to produce horizontal, or axial, images of the body.

Sputum cytology studies phlegm (mucus) cells under a microscope.

Thoracentesis, where a hollow needle is inserted through the skin in the chest wall to remove fluid (when present), which is then sent to the lab to be checked for cancer cells.

Biopsy performed using either a closed or an open method. Closed methods are performed through the skin or through the trachea (windpipe). An open biopsy is performed in the operating room under general anesthesia.

Needle biopsy, a thin, hollow needle is guided into the mass while the lungs are being viewed on a fluoroscopy or CT scan. A sample is removed and evaluated under a microscope. Also called a closed, transthoracic, or percutaneous (through the skin) biopsy. A needle biopsy may also be performed during a bronchoscopy

Thoracoscopic biopsy, also referred to as video-assisted thoracic surgery (VATS) biopsy, is an operation where the surgeon makes one or more small cuts in the side of the chest wall, under anesthesia, through which a small telescope with a video camera on the end is inserted. This allows the doctor to look at the outer part of the lungs and chest wall and to sample any abnormal areas for viewing under a microscope. Therapeutic procedures, such as the removal of a nodule or other tissue may be performed. Depending on the results of the biopsy, more extensive surgery, such as the removal of a lobe of the lung, may be performed during the procedure.

Bronchoscopy, which is the examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope) passed down the mouth or nose. Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or to help remove a foreign body.

 

Transbronchial biopsy is performed through a fiberoptic bronchoscope (a long, thin tube that has a close-focusing telescope on the end for viewing) through the main airways of the lungs (bronchoscopy).

Endobronchial ultrasound, a specialized technique combining bronchoscopy with an ultrasound that enables clinicians to visualize lymph nodes with high sensitivity, and allows a biopsy without an incision.

Mediastinoscopy, a small incision is made in the neck above the top of the sternum under general anesthesia and a mediastinoscope is inserted to see into the chest cavity and obtain tissue samples of mediastinal lymph nodes. This procedure helps in staging the cancer or making the diagnosis of the cancer.

MRI, PET, or bone scans determine if the cancer has spread from where it started into other areas of the body.

 

The Screening program for Lung Cancer offers eligible patients CT scans to screen for lung cancer. Eligible patients must be between the ages of 55 and 79 who smoked one pack of cigarettes a day for 25 years.

 

Treatment for Lung Cancer

Depending on its type and stage, lung cancer may be treated with surgery, chemotherapy, radiation therapy, local ablation including laser therapy, or a combination of treatments. Treatment options include:

Surgery,

Surgery is usually the best option for treating early-stage lung cancer and may be used to remove a portion of the lung or the entire lung. Our thoracic surgeons have pioneered the use of minimally invasive video-assisted thoracic surgery (VATS), and continue to develop innovative approaches to achieving the best outcomes for lung cancer patients.

 

Types of Surgery

 

  • Segmental or wedge resection: Removal of only a part of the lung. There are 10 segments in each lung.
  • Lobectomy: Removal of an entire lobe of the lung. There are 3 lobes in the right lung and 2 in the left lung.
  • Pneumonectomy: Removal of an entire lung.
  • Sleeve resection: Removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus.
  • Open-chest surgery: Open procedures are less common, as minimally invasive surgeries are easier on the patient and equally effective. Sometimes, major open surgery is required, such as when the tumor is very large.
  • Minimally Invasive Surgery

Using minimally invasive surgery techniques over traditional surgeries offers patients many benefits: improved accuracy and visualization, minimized trauma to tissue, less bleeding, decreased pain, less scarring and a shortened recovery.

Segmental/wedge resection and lobectomy are both done with minimally invasive surgical procedures that use small incisions and specialized instruments with video-scopes to guide the surgical process.

Many patients come to us after learning they are not candidates for traditional surgery, and we are able

to provide innovative surgical options that are safe and effective. Surgical techniques include:

Video-assisted Thoracic Surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into small incisions in the chest. Open lung resection for cancer often requires a large thoracotomy incision with spreading of the ribs. VATS lobectomy uses three small incisions without any spreading of the ribs. A camera is used to assist the dissection of sensitive blood vessels and lung structures. Less pain and quicker recovery are the goals. If chemotherapy is necessary after surgery, patients are healthier and can more reliably begin their adjuvant additional therapy.

6. Lung Nodule

Lung tissue is similar to a sponge, made up of tiny air sacs and blood vessels that function to supply oxygen to the body. A lung nodule is a solid area like a marble embedded in the sponge. Many things can produce a lung nodule: an enlarged lymph node, an old pneumonia or infection, phlegm impacted in a tiny airway or many other causes. Unfortunately, cancers can also produce and appear as lung nodules.

The risk that any nodule is cancerous depends most importantly on the size. In general, nodules that are less than 6 mm (1/4 inch) in diameter are followed with a repeat chest CT scan due to the low risk of cancer (ten percent or less), unless some other feature is felt to increase the probability of cancer. Nodules greater than 10 mm in diameter should be biopsied or removed due to the 80 percent probability that they are malignant. Nodules between 6 mm and 10 mm need to be carefully assessed. Nodules greater than 3 cm are referred to as lung masses.

a/Causes Lung Nodules:

  • Enlarged lymph nodes.
  • Infections such as pneumonia or tuberculosis
  • Lung diseases are caused by fungus.
  • Phlegm impacted a tiny airway.
  • Scars
  • Cysts
  • Lung cancer

b/Treatment Lung Nodules

The next step will depend on the size and radiographic appearance of the nodule. Your surgeon may recommend surgical removal or additional testing. The intention is to keep you safe from an undiagnosed cancer, while only recommending an invasive procedure if absolutely necessary.

7. Pneumothorax

Pneumothorax is more commonly known as a collapsed lung. It occurs when air from the lung leaks into the area between the lung and the wall of the chest cavity (rib cage). This air puts pressure on the outside of the lung, so it cannot expand normally, leading to difficulty breathing. This situation can be life threatening and requires immediate treatment.

 

Diagnosis of Pneumothorax

 

After taking your medical history and performing a careful physical examination, your Lung Center team may order the following tests to confirm a pneumothorax:

 

Chest CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat and organs.

Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media.

 

Treatment of Pneumothorax

 

Depending on the severity of your pneumothorax, there are several treatment options:

 

Observation: If your lung collapse is small, your condition will be monitored with a series of chest X-rays, usually in the hospital. You may need to use supplemental oxygen. Sometimes the air can be reabsorbed and your lung returns to normal after a week or two.

Needle or chest tube insertion: If your lung collapse is larger, or air continues to leak, a needle or chest tube is inserted to remove the air.

Minimally invasive surgical treatment: If the needle or chest tube does remove the air successfully, video-assisted thoracic surgery (VATS) may be required to close the leak particularly when this is a recurrent problem. A small telescope is inserted and the source of the air leak is stapled closed. After surgery, you can expect to stay in the hospital for a few days recovering.

Central Nervous System
Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.
Allergic Disorders
Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.
Neoplastic Disorders
Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.

Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies, academic scientists, and governments. As a result of this complex path from discovery to commercialization, partnering has become a standard practice for advancing drug candidates through development pipelines. Governments generally regulate what drugs can be marketed, how drugs are marketed, and in some jurisdictions,

Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies, academic scientists, and governments. As a result of this complex path from discovery to commercialization, partnering has become a standard practice for advancing drug candidates through development pipelines. Governments generally regulate what drugs can be marketed, how drugs are marketed, and in some jurisdictions,

Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies, academic scientists, and governments. As a result of this complex path from discovery to commercialization, partnering has become a standard practice for advancing drug candidates through development pipelines. Governments generally regulate what drugs can be marketed, how drugs are marketed, and in some jurisdictions,

Drug discovery and drug development are complex and expensive endeavors undertaken by pharmaceutical companies, academic scientists, and governments. As a result of this complex path from discovery to commercialization, partnering has become a standard practice for advancing drug candidates through development pipelines. Governments generally regulate what drugs can be marketed, how drugs are marketed, and in some jurisdictions,

Chest CT Scan

Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the ‘parent’ organization of the American Thoracic Society

One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulation. Originally, it was thought that blood reaching the right side of the heart passed through small ‘pores’ in the septum into the left side to be oxygenated, as theorized by Galen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no ‘direct’ passage between the two sides.

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Consultant Surgeon ( Chief of Surgery) Advanced Minimally invasive Laprascopic Surgeon