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Thoracic Surgery

What is Thoracic Surgery?

The Thoracic Surgeon or Chest Surgeon is the one who has specialist skills in the surgery for the diseases of the Lung, Airway, Mediastinum, Chest wall and esophagus (food pipe), unlike cardiovascular surgeon who deals with the ailments of the heart. The specialty deals with management of patients with chest trauma, lung cancer, esophageal cancer, empyema, lung abscess, Bronchiectasis, airway problems like tracheal strictures, mediastinal tumors, diaphragmatic rupture or hernia and more. The most common symptoms of these conditions are persistent cough, coughing of blood (haemoptysis), chest pain, weight loss, difficulty in breathing, unusual noise (stridor or wheeze) during breathing, change in voice and difficulty in swallowing.

The skills of thoracic surgeon or chest surgeon are very demanding which include; bronchoscopy (flexible or rigid), mediastinoscopy, thoracoscopy (also known as VATS) and thoracotomy or sternotomy and procedures like decortication, lung resection, bronchoplasty, mediastinal tumor excision, pericardial window and many more. Thoracoscopy is the keyhole surgery in the chest or otherwise minimally invasive surgery of the chest and is also called VATS (Video Assisted Thoracoscopy Surgery).

The following are some of the important diseases and the treatments, in summary, in thoracic surgery

  • The most frequently encountered, curable, conditions in the young patients are mediastinal lymphadenopathy requiring mediastinoscopy or thoracoscopy, spontaneous pneumothorax requiring VATS bullectomy and pleurodesis, hyperhidrosis (excess sweating) of hands & face requiring VATS sympathectomy, pleural effusion requiring VATS biopsy.

  • There is high prevalence of chest trauma in road traffic accidents or motor vehicle accidents. With the increasing number of vehicles and even more danger is of the rash speedy driving, resulting in more accidents. Many such patients, most often being young, are succumbing to these injuries without appropriate care. Overall, thoracic injuries are directly responsible for up to 20-25% of all deaths after trauma. Furthermore, chest trauma is implicated as a contributing cause of death in an additional 25% of patients who die from their injuries.

  • The most frequently encountered clinical conditions in our country is infections such as pneumonia, empyema, bronchiectasis, drug resistant tuberculosis, aspergiloma and lung abscess. It requires great deal of expertise in understanding the pathophysiology and to carryout appropriate surgical procedure suitable for the individual patient. The simple procedures like chest drain insertion and bronchoscopy clearance could save many lives who may otherwise suffer or succumb to these infections.

  • It is predicted to have an increasing number of lung cancer patients in India in view of growing tobacco consumption habits. At present the surgery, the only chance for cure, is offered only to dismal number of patients in developing countries, compared to about 25-30% of patients diagnosed with lung cancer in the west.

  • We in India are continuing to use asbestos in industries such cement, asbestos sheet manufacturing while it is banned in many countries. It is well known to give rise to very serious health problem; deadly cancer known as mesothelioma apart from various other illnesses like pulmonary fibrosis, lung cancer.

Patient Care

The Division of Thoracic Surgery is dedicated to the prevention, early diagnosis and treatment of (non-cardiac) diseases of the chest. We provide service to a broad range of thoracic issues at Nidhi Hospital, including:

  • Lung Cancer
  • Benign Esophageal Disease
  • Mediastinal Diseases and Masses / Thymoma
  • Thoracoscopic Sympathectomy for Hyperhidrosis
  • Esophageal Cancer
  • Chest Wall
  • Diseases of the Airway
  • Video-assisted Thoracic Surgery

Lung Cancer

We consider excellence in surgery for lung cancer to be at the core of the mission of the Thoracic Surgery service at Nidhi Hospital. You will be treated at Nidhi Hospital by thoracic surgeons who are super-specialized in the management of lung cancer and have trained to treat this disease at some of the top thoracic surgery units in the country. We work together with oncologists, radiation oncologists, pathologists, and radiologists at the Nidhi Hospital to provide a comprehensive approach to therapy. The Doctor’s team of lung cancer specialists who are specially trained to perform all of the different types of lung cancer resections that might be required – with the lowest risk and greatest chance of cure. Several studies have now demonstrated that risks are lower and cure rates higher when lung cancer procedures are performed by surgeons, such as those at Nidhi Hospital, who are specialized in these techniques.

Benign Esophageal Disease

At Nidhi Hospital, we provide a wide range of minimally invasive surgical treatments for gastroesophageal reflux disease (GERD), achalasia, paraesophageal hernia, and Barrett’s esophagus. Minimally invasive treatments are beneficial because, in some cases, they may eliminate the need for more complex surgeries, and in most cases, minimally invasive treatments reduce the patient's length of hospital stay and shorten recovery time. We have general thoracic surgeons that are specially trained in these methods to treat non-malignant esophageal diseases.

Mediastinal Diseases and Masses / Thymoma

Nidhi Hospital thoracic surgeons evaluate and treat a high volume and wide variety of mediastinal diseases. Since many of these lesions are benign, minimally invasive approaches, which allow for less discomfort and faster recovery, can often be utilized. As in all areas of thoracic surgery, Nidhi Hospital thoracic surgeons have sub-specialty training in the surgical management of mediastinal tumors and diseases.

Thoracoscopic Sympathectomy for Hyperhidrosis

Nidhi Hospital surgeons have performed VATS sympathectomies, representing a very extensive experience and demonstrating our significant commitment to the care of patients with hyperhidrosis.

Esophageal Cancer

Although the incidence of esophageal cancer is steadily rising, few surgeons get extensive experience with surgical diseases of the esophagus. The Division of Thoracic Surgery has extensive experience with the management of cancer of the esophagus, including resection of the esophagus with reconstruction and restoration of swallowing, as well as endoscopic management of esophageal obstruction (laser and stenting). A multidisciplinary approach to patients with esophageal cancer, either through direct referral or through the GI Multidisciplinary Tumor Board, is utilized in selected patients where a combination of surgery, chemotherapy, and radiation therapy may be helpful.

Chest Wall

Chest wall tumors are uncommon and pose problems with both diagnosis and management. While the lesions are often apparent on physical examination or radiographic studies, a firm diagnosis may require an open, rather than needle, biopsy. Chest wall resection, with or without removal of adjacent lung tissue, can be treated without surgery. Chest wall reconstruction may require placement of prosthetic materials and rotation of muscle flaps to create cosmetically acceptable and functional results. Patients with chest wall tumors may benefit from evaluation in the Comprehensive Thoracic Oncology as multidisciplinary approaches involving surgery, chemotherapy, and radiation therapy may be necessary.

Diseases of the Airway

Diseases of the trachea and major airways are uncommon; however, the Division of Thoracic Surgery has been interested in such diseases for years. Procedures such as tracheal resection, rigid bronchoscopy, laser ablation of tracheal tumors, and tracheal stenting are offered.

Video-assisted Thoracic Surgery

The field of minimally invasive surgery has expanded dramatically. Initially used primarily by gynecologists, minimally invasive techniques and equipment were adapted for general surgical (abdominal) procedures and subsequently for intrathoracic use of procedures such as pulmonary resection, pleural biopsy, removal of mediastinal tumors, and sympathectomy (for reflex sympathetic dystrophy and hyperhydrosis). Please see our other sections listed below that highlight use of video-assisted thoracic surgery for the treatment of specific thoracic problems:

  • VATS lobectomy
  • VATS sympathectomy
  • VATS removal of mediastinal masses

 
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