Understanding Thoracic Surgery

Thoracic surgery  

“Thoracic” refers to the thorax or in layman’s jargon,  the chest. The chest cavity contains the heart, lungs, oesophagus, chest wall and diaphragm. The organs inside the chest are protected by the rib cage. Thoracic Surgery is the science which deals with surgical diseases of the chest. A thoracic surgeon provides operative, perioperative, and surgical critical care of patients with a large number of  acquired and congenital pathologic conditions within the chest.

These include:

  •     Lung cancer
  •     Benign diseases and tumors of the lung
  •     Chest reconstruction after major trauma or surgery
  •     Lung volume reduction surgery for emphysema
  •     Esophageal cancer
  •     Benign esophageal diseases (including achalasia, benign tumors and strictures)
  •     Esophageal reconstruction
  •     Gastroesophageal reflux
  •     Mediastinal tumors and diseases (including the surgical treatment of myasthenia gravis)
  •     Mesothelioma
  •     Pleural diseases (including pneumothorax, infections and pleural effusions)
  •     Chest wall tumors
  •     Sympathectomy for hyperhidrosis (excessive sweating)
  •     Plication for diaphragm paralysis and eventration
  •     Tracheal resection or stent insertion for airway narrowing

The 3 ways of doing thoracic surgery:

Traditional open surgery:  This is a technique where the chest is opened by an incision. While there has been a tendency to denigrate open thoracic surgery calling it “back dated” the truth is very different. In many complex cases, traditional open surgery provides surgeons better access to the area to be treated. Sometimes a patient’s age, physical condition and surgical history may necessitate open surgery. In recent times, it has been possible, in many cases to use state-of-the-art robotic-assisted technology or endoscopic techniques,to perform complex and delicate procedures through small incisions with unmatched precision.

Non-robotic minimally invasive surgery (endoscopic): Non-robotic minimally invasive surgery is also known as endoscopic surgery. You also may be familiar with terms like VATS,thoracoscopic surgery, or “keyhole” surgery. These are minimally invasive procedures that utilize an endoscope to reach internal organs through very small incisions.During endoscopic surgery the surgeon inserts a thin, flexible tube with a video camera through a small incision or a natural orifice like the mouth or nostrils. The tube has a channel to utilize tiny surgical instruments, which the surgeon uses while viewing the organs on a computer monitor.This technique allows the surgeon to see inside the patient’s body and operate through a much smaller incision than would otherwise be required of traditional open surgery.

 Robotic surgery: Advanced robotic systems give doctors greater control and vision during surgery, allowing them to perform safe, less invasive, and precise surgical procedures.During robotic-assisted surgery, surgeons operate from a console equipped with two master controllers that maneuver four robotic arms. By viewing a high-definition 3-D image on the console, the surgeon is able to see the surgical procedure better than ever before. Computer software takes the place of actual hand movements and can make movements very precise. The benefits of minimally invasive surgery can include:

  •     Small incisions
  •     Less pain
  •     Low risk of infection
  •     Short hospital stay
  •     Quick recovery time
  •     Less scarring
  •     Reduced blood loss

While minimally invasive surgery effectively reduces time and gives surgeons greater control, and benefits in many ways, contrary to projections in the media and propaganda, it is not suitable for everyone and cannot achieve equivalent results (as compared to open surgery) in many cases.

It is also definitely more expensive than open surgery. The correct approach is therefore to choose the surgical technique which is appropriate and meets the patient’s needs and can resolve the clinical problem. Dr  S Bal is adept and competent in open surgery and also in all forms of minimal access surgery, be it VATS or Robotic assisted surgery. More importantly, he is committed to providing innovative and safe alternatives where traditional open surgery can be avoided or is not required.This ensures that he offers the right surgical treatment approach to every patient, depending on his disease, without any other extraneous consideration.