Thoracic
Surgery - Thorax Definition, Types of Thoracic Surgery, The Society
for Thoracic Surgeons, Video Assisted Thoracic Surgery (VATS), How
to Prepare & Risks Involved
(August 25th, 2008)
 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:
i) 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).
ii) 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.
iii) 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
|
