Thoracic Surgery: Definition, Types, Video Assisted Thoracic Surgery (VATS), How to Prepare and Risks Involved

Thoracic Surgery

The term “Thoracic” derives form the word Thorax, which stands for the breasts or chest from ancient Latin & Greek languages.

Thorax refers to the area of the body that is located between the neck and the abdomen including organs such as the heart, the great vessels, esophagus, lungs, trachea, pleura, mediastinum, the chest wall and diaphragm.

Thoracic surgery is the use of medicine to treat diseases of the chest including lung cancers, coronary artery diseases, tumors contained in the chest cavity, heart & lung transplants, and abnormalities of the great vessels and heart valves.

Thoracic surgeons are some of the most highly educated surgeons because after college and medical school, they have to spend 5 years in a general surgical residency, another 2-3 years to thoracic surgery residency and pass a tough examination set by the American Board of Thoracic Surgery.

The patient is placed under general anesthesia and endotracheally intubated. The exact procedure varies on what organ of the body is undergoing surgery but usually, a cut is made to the chest allowing the surgeon to gain access to the thoracic cavity.

The incision (cut) is made beginning from the back under the shoulders and extends under the arm to the front of the chest. The ribs are spread with a retractor and the muscles are cut.

A good example of a thoracic surgery is shown in the image above. The pleural cavity is penetrated into via a limited incision into the 5th intercostal space, through which any lung masses and enlarged lymph nodes are removed.

Video Assisted Thoracic Surgery (VATS)

Video Assisted Thoracic Surgery (VATS) is a surgical procedure that is used to diagnose, detect & treat malignant tumors in the lungs or in the chest cavities or the thorax.

A tiny camera with a light source is inserted into the chest or thorax via an incision between the ribs. The camera that surgeons use is known as a thorascope.

A thorascope is a minimally invasive surgical fiber-optic camera that is passed on to near the lungs to help surgeons see where the tumor lies in the lungs.

It is inserted into the chest via an incision and transmits images of the interior of the chest and outputs it to a video monitor located in the surgeon’s office.

This video monitor output helps the surgeon guide his incision tools into the chest so as to reach out to where the tumor is. Video-assisted thoracoscopic surgery replaces traditional thoracotomy which requires a larger incision into the chest and also results in a greater amount of pain.

Take a look at the image on the side to get an understanding of how thorascopic lobectomy works. A stapler is inserted into the chest wall that also houses a video thorascope.

The images are transmitted from this thorascope into a video monitor output that helps the surgeon guide his instruments.

To summarize, here’s how a thorascopic lobectomy operations works:

  • 3 small incisions are created between the ribs that allow a video thorascope to be inserted near the chest as well as a stapler (surgical equipment).
  • Next, the lobe where the tumor lives is removed. Surgeons make sure that these tissues are removed so that the tumor does not develop again.
  • Finally the surgeon will extract lymph glands from the chest in order to make an acccurate lung cancer staging.

How to Prepare for Thoracic Surgery

Patients who want to undergo general thoracic surgery must check up their medical histories and conduct a thorough physical examination, with more attention given to the respiratory system.

If the patient is smoking, it is advised he/she stop smoking before the thoracic surgery to avoid chances of any complications & problems that could arise from the surgery.

Patients should not eat for 10 – 12 hours before the thoracic surgery and sedative medicine may be provided to the patients for relaxation & ease of anxiety.

The patient usually feels severe pain after the surgery and thus is fed with analgesics and other medicines to lessen the pain. Chest tubes are monitored for signs of fluid & air accumulation in the lungs.

A A urinary catheter is also given to the patient for 24 to 48 hours to drain urine from the bladder.

Risks of Thoracic Surgery

Just like any other type of surgery, there are risks associated with conducting thoracic surgeries. These include:

  • Respiratory failure (which is why smoking patients are advised to stop smoking for atleast a few months before undergoing the surgery)
  • Heart attack & stroke
  • Infection & other side effects
  • Hemorrhage
  • Injuries to the nerves

dr. Bulawan

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