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Thoracic Surgery: Meaning, Scope, and Other Details

Team AckoJul 4, 2024

Thoracic Surgery is a vital part of the medical field that focuses on the comprehensive care of various chest disorders. This specialised discipline encompasses the intricate diagnosis, treatment, and management of conditions affecting the thoracic cavity's complex structures.

From addressing ailments of the heart, lungs, and major blood vessels to managing disorders of the oesophagus, Thoracic Surgery plays a pivotal role in restoring and preserving patients' health and well-being.

Surgeons in this field employ advanced techniques and technologies to deliver precise interventions, ranging from minimally invasive procedures to complex open surgeries. Through their expertise, thoracic surgeons contribute significantly to improving outcomes and quality of life for individuals facing a spectrum of thoracic ailments. In this article, we will explore the world of Thoracic Surgery. Let's dive in.

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Contents

What is Thoracic Surgery?
What are the common types of Thoracic Surgery?
Conditions treated by Thoracic Surgery
Surgical techniques used for Thoracic Surgery
Pre-surgery considerations
How to prepare for Thoracic Surgery
Recovery after Thoracic Surgery
How serious is Thoracic Surgery?
What to expect following Thoracic Surgery?
- Careful monitoring
Advancements in Thoracic Surgery techniques
- Evolution of Thoracic Surgery for malignancies
- Advances in Esophageal Surgery
Frequently Asked Questions (FAQs)

What is Thoracic Surgery?

Thoracic Surgery is a specialty of medicine that focuses on the treatment of chest-related illnesses and disorders. Thoracic surgeons are highly competent physicians who specialise in the diagnosis and surgical treatment of problems affecting these essential structures. Thoracic Surgery's major purpose is to enhance a patient's health and quality of life by treating chest diseases.

Lung cancer, collapsed lungs, tumours, infections, congenital anomalies, and esophageal illnesses are examples of such ailments. Often, thoracic surgeons collaborate with other medical specialists, including radiologists and oncologists, to correctly diagnose problems and devise treatment regimens. They evaluate each patient's unique circumstances and recommend the best surgical technique or combination of therapies, ensuring the best potential outcome.

What are the common types of Thoracic Surgery?

Here are some of the common types of Thoracic Surgery.

Lung Resection includes removing a piece of the lung that has been impacted by disorders such as lung cancer, infections, or nodules. Wedge resection, segmentectomy, lobectomy, and pneumonectomy are all forms of lung resection.
Coronary artery bypass grafting (CABG) is a form of Thoracic Surgery used to treat coronary artery disease (CAD). CAD develops when the blood passages that deliver oxygen and nutrients to the heart muscle, known as coronary arteries, become constricted or obstructed owing to plaque formation.
Thoracoscopy, or video-assisted thoracoscopic surgery (VATS), is a minimally invasive method that visualises and operates on the chest cavity using tiny incisions and a camera. It is utilised for lung biopsies, pleural effusion therapy, and the identification of certain lung diseases.
Lobectomy is the surgical removal of a complete lung lobe.
Esophagectomy involves the removal of all or part of the food pipe (oesophagus), usually for the treatment of esophageal cancer or severe esophageal conditions. The remaining healthy part of the oesophagus is then reconnected to the stomach or a portion of the small intestine.
Chest Wall Resection and Reconstruction is a procedure used to remove tumours or repair abnormalities in the chest wall caused by trauma, infections, or certain malignancies.

Conditions treated by Thoracic Surgery

Thoracic surgery encompasses a range of procedures aimed at addressing various conditions affecting the chest and upper abdomen. These surgeries are crucial in treating a multitude of issues, including stretched blood vessels (aneurysms), congenital heart defects, irregular heart rhythms, heart failure, coronary artery disease, and the need for heart or lung transplants.

Additionally, thoracic surgeons are adept at managing heart valve disorders, lung cancer, and tumours in the oesophagus or thymus. They also play a pivotal role in addressing swallowing difficulties (dysphagia), gastroesophageal reflux disease (GERD), Barrett's oesophagus, and hiatal hernias.

Through precise surgical interventions, thoracic surgeons aim to alleviate symptoms, improve quality of life, and, in many cases, save lives by effectively managing these complex conditions that impact the vital organs within the chest and upper abdominal cavity.

Surgical techniques used for Thoracic Surgery

Thoracic Surgery includes many procedures depending on the specific condition being treated.

Open surgery: This includes creating a bigger incision in the chest to provide access to the thoracic cavity. It enables broad surgical interventions and difficult treatments by providing direct visibility and access to the region.

Minimally Invasive Surgery (MIS): Minimally invasive procedures are gaining traction as surgeons tilt towards conservative approaches. They minimise incision size, less discomfort, faster recovery, and better cosmetic outcomes. MIS is usually done via Video-assisted Thoracoscopic Surgery and Robotic-Assisted Thoracic Surgery.

Pre-surgery considerations

Thoracic surgeries are major surgeries and need critical planning.

A thorough examination of the patient's general health and particular problem is required before Thoracic Surgery. This examination determines if the patient is a good candidate for surgery and examines the risks and potential benefits.

Doctors review the medical history, including previous operations, allergies, and any underlying health concerns.

A physical exam is conducted to evaluate the patient's overall health, lung function, and cardiovascular fitness. This helps assess their tolerance for surgery and anaesthesia.

Blood tests, electrocardiograms (ECGs), chest X-rays, and lung function tests may be performed to acquire further information about the patient's health.

How to prepare for Thoracic Surgery

Here is a guide to help you get ready.

Schedule a meeting with your thoracic surgeon. They will review your case and may also perform a physical examination and order additional tests or imaging to assess your overall health and the specific condition needing surgery.

Make sure to follow the instructions given by your surgical team. Your surgeon will let you know which medications to continue or stop before surgery. You'll be asked to avoid eating or drinking for a certain period before surgery. If you smoke, it's strongly advised to quit before surgery.

Surgery can be emotionally challenging. Don't hesitate to ask your surgeon any questions or share any concerns you have about the procedure or recovery process. Having a clear understanding will help ease your worries.

Talk to friends, family, or support groups about your feelings and fears. Sharing your emotions can provide comfort and reassurance during this time. Enlist the help of a family member or friend who can assist you with everyday tasks like cooking, cleaning, and managing medications during your recovery period.

Your surgeon will instruct you and prepare any recommended supplies or equipment in advance, like compression stockings or mobility aids.

Recovery after Thoracic Surgery

Do’s:

Stick to the post-operative care plan provided by your healthcare team. This includes taking medications as prescribed, following wound care instructions, and attending follow-up appointments.
Keep the incision site clean and dry as per the instructions provided.
Take pain medications as prescribed by your healthcare team to control post-operative pain.
Take a balanced diet to fasten healing.
Take rest and gradually increase physical activity. Begin with gentle activity, such as short walks, as your healthcare team advises.

Don'ts:

Don't ignore severe pain or pain that grows with each passing day.
Don't force yourself into sudden strenuous activities.
Don't ignore follow-up appointments.

How serious is Thoracic Surgery?

Thoracic Surgery is indeed serious due to the critical nature of the organs it addresses - the heart and lungs. These vital organs are essential for sustaining life, requiring precise care and attention. From complex procedures addressing multiple heart issues to minimally invasive lung surgeries, the spectrum of interventions underscores the seriousness of this field. Patients undergoing thoracic surgery often face significant health challenges, needing a multidisciplinary healthcare approach to ensure optimal outcomes.

Surgeons, alongside dedicated medical teams, collaborate closely to provide individualised care, prioritising both the efficacy and safety of the procedures. With a focus on delivering the best surgical outcomes, Thoracic Surgery remains a crucial component in the management of chest disorders, emphasising the gravity of its role in maintaining and restoring patients' health.

What to expect following Thoracic Surgery?

After thoracic surgery, the postoperative period is carefully managed to ensure a smooth recovery. Initially, patients wake up in a recovery room or intensive care unit under close monitoring by medical staff. The breathing tube inserted during surgery is typically removed once you're awake and stable. Tubes may remain in your chest to drain fluids, and a catheter in your bladder aids in urine collection.

As your condition stabilises, you'll transition to a regular hospital room. Early mobilisation is encouraged, with assistance provided for walking around your room and hallway. This helps prevent complications such as blood clots and promotes faster recovery. Breathing exercises are also introduced to facilitate lung expansion and prevent pneumonia.

Careful monitoring

Throughout your hospital stay, your healthcare team monitors your progress closely, adjusting treatment as needed. Once you meet specific recovery milestones set by your provider, you'll be discharged home. The length of hospitalisation varies depending on the complexity of the surgery and individual recovery progress, typically ranging from three to 10 days.

Upon discharge, follow-up appointments and instructions for home care, medication, and activity level will be provided to support continued healing and recovery. It's essential to adhere to these guidelines and communicate any concerns with your healthcare team to optimise your post-operative recovery journey.

Advancements in Thoracic Surgery techniques

During the 1920s, thoracic surgery progressed slowly, hindered by the lack of advanced techniques and the inherent risks of opening the chest cavity. However, in the 1930s, significant improvements in anaesthetic techniques catalysed a revolution in thoracic surgery. One pivotal advancement was the introduction of Harold Brunn's individual-structure ligation technique in 1929.

This innovative approach replaced the cumbersome two-stage snare or tourniquet technique for lung resection, significantly reducing complications such as air leaks, tension pneumothorax, haemorrhage, and infections from necrotic residual tissue.

Rudolph Nissen's groundbreaking two-stage pneumonectomy in 1931 and Evarts Graham's one-stage total pneumonectomy for lung cancer in 1933 marked significant milestones in the field. These procedures showcased the evolving trajectory of thoracic surgery, transforming it from a risky last resort for refractory infections to a viable treatment option for malignancies.

Evolution of Thoracic Surgery for malignancies

The 1930s witnessed a paradigm shift in the role of thoracic surgery, with a notable focus on treating malignancies. Previously, opening the chest had been deemed extremely risky and was primarily reserved for severe infections.

However, with the advent of safer techniques and improved post-operative care, thoracic surgery emerged as a promising avenue for treating cancer. The introduction of routine post-operative pleural drainage through closed chest thoracostomy further facilitated surgical progress, reducing the risk of complications and improving patient outcomes.

Advances in Esophageal Surgery

Alongside the progress in thoracic surgery for lung conditions, significant advancements also occurred in oesophagal surgery during the 1930s. Notably, the first successful transthoracic esophagectomy with an intrathoracic esophagogastric anastomosis was performed in Japan in 1933. This achievement highlights the expanding scope of thoracic surgery and its potential to address a wide range of conditions as thoracic anaesthesia continues to improve.

Frequently Asked Questions (FAQs)

Here are some frequently asked questions on Thoracic Surgery.

What conditions can be treated with Thoracic Surgery?

Thoracic Surgery is used to treat a range of conditions involving the organs and structures within the chest. Some common conditions include lung cancer, esophageal cancer, mediastinal tumours, emphysema, pneumothorax (collapsed lung), thoracic outlet syndrome, chest wall deformities, and diseases of the heart and major blood vessels.

Will I have scars after Thoracic Surgery?

The appearance of scars following Thoracic Surgery depends on the type of procedure performed. Traditional open surgeries usually involve larger incisions, which can leave more noticeable scars. On the other hand, minimally invasive techniques like VATS or robotic-assisted surgery use smaller incisions, resulting in smaller scars that are often less visible. The scars often resolve with time.

How can I prepare for Thoracic Surgery?

A doctor will evaluate your vitals, and medical history and give you X-rays/CTs /MRIs to prepare a proper plan. You will need to follow instructions throughout the surgery phases. A doctor will guide you on what to do and what to avoid.

Are there any risks or complications associated with Thoracic Surgery?

Risks such as infection, bleeding, blood clots, damage to surrounding structures, adverse reactions to anaesthesia, and complications specific to the operated organ (e.g., air leaks after lung surgery) are possible. The healthcare team will discuss the potential risks and complications with the patient before the surgery and take appropriate measures to minimise them.

How long does it take to recover from Thoracic Surgery?

Minimally invasive procedures like VATS or robotic-assisted surgery generally have shorter recovery times compared to traditional open surgeries. In general, patients may spend a few days to a week in the hospital, followed by several weeks to a few months of gradual recovery at home. The healthcare team will provide specific post-operative care instructions and guidelines for a successful recovery.

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009067/

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.