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Thoracic Surgery

Overview

The department of Thoracic Surgery at Fortis Memorial Research Institute, provides services for the surgical treatment of benign and malignant diseases of the chest other than heart .

We provide a complete range of services, from initial evaluation and management for rare and complex diseases and new surgical approaches, device, and technologies. We collaborate with experts in many specialties providing multi-disciplinary approach for treatment of these complex disorders.

Scope of Services

Diagnostic thoracoscopy

Thoracoscopy is recommended to establish a diagnosis in patients with undiagnosed pleural effusions. It allows direct visual assessment of the pleura and subsequent biopsy of visually abnormal areas, hence maximising diagnostic yield.

Lung Diseases
  • Bronchiectasis
    • Bronchiectasis is a disease in which there is permanent enlargement of the airways of the lung. Common symptoms are cough with excessive sputum, blood in cough, foul smelling breath, frequent chest infections and breathlessness. Causes can be both since birth and acquired. Surgical removal of the diseased lung is advised in patients not responding to medical treatment.
  • Aspergilloma
    • An aspergilloma, is also known as a mycetoma or fungus ball, occurs in patients with pre-existing cavitatory lung diseases such as tuberculosis. It may be asymptomatic, cause cough, blood in cough or life threatening bleeding. Surgical removal of diseased lung in symptomatic patients may provide cure.
  • Hydatid cyst in lung
    • Hydatid disease is a parasitic infestation caused by tapeworm Echinococcus. It can also occur in lungs along with other parts of the body. Common symptoms are chest pain, cough, breathlessness and blood in cough. Treatment of choice is surgical removal of the disease.
  • Lung bullae and blebs
    • Bullae. Lung bulla is a thin air sack filled with air and are very fragile to burst. These can burst and the entire lung may collapse resulting from pneumothorax. Surgery is usually needed in patients with: large bullae causing breathlessness, increasing size of bulla, recurrent pneumothorax, infected bullae not responding to medical treatment, acute respiratory failure, and acute distension of the bulla. Vats/uniportal vats is offered to these patients with excellent outcomes.
  • Emphysema (Lung Volume Reduction Surgery)
    • V Emphysema is a disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). Lung volume reduction surgery (LVRS) is a surgical procedure to remove diseased, emphysematous lung tissue. LVRS improves exercise capacity, lung function and quality of life. Minimal access offered to these patients with excellent outcomes
  • Lung Nodules
    • Nodules can occur in lungs due to various causes ranging from infection to cancer and metastasis. evaluation and surgical resection by minimal access means
  • Lung cancer
    • Lung cancer is the leading cause of cancer-related deaths in India and globally. People who smoke have the greatest risk of lung cancer, though lung cancer can also occur in people who have never smoked. The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pain. Minimally invasive techniques are adopted to do these surgeries.
Pleural cavity
  • Empyema
    • Empyema is a collection of pus in between the lung and the inner surface of the chest wall (pleural space). Common causes for empyema are tuberculosis, pneumonia, ,trauma , complication from lung surgery, or inoculation of the pleural cavity after needle aspiration or chest tube placement. Sometimes a peel forms over the lung surface and inner lining of chest which restricts the expansion of lung along with poor penetration of antibiotics. VATS decortication is required to remove all the pus from the chest cavity and the peel is completely removed to allow the lung to expand.
  • Hemothorax
    • Hemothorax is when blood collects between the chest wall and the lungs. Most common cause of hemothorax is chest injury. Hemothorax is commonly treated by inserting a tube in chest cavity. Sometimes the blood gets clotted or loculated or may get infected to form an empyema. These patients often need surgical drainage. Minimally invasive techniques are adopted for drainage and decortication.
  • Chylothorax
    • Results from leakage of lymphatic fluid from thoracic duct. Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.
      Pleurodesis can be undertaken during thoracoscopy in cases of recurrent effusions due to malignancy or other chronic diseasedirect inspection to prevent recurrence of pleural effusion.
Mediastinum

Mediastinum is an area found in the midline of the chest that is surrounded by the breastbone in front, the spine in back, and the lungs on each side. It contains the heart, thymus gland, portions of the esophagus and trachea, and other structures. Mediastinal masses Mediastinal masses are caused by a variety of cysts and tumors. Likely causes differ by patient age and by location of the mass (anterior, middle, or posterior mediastinum). Mediastinal tumors (both benign and malignant) that are left untreated can cause serious complications including invading the heart, pericardium (the lining around the heart), and great vessels (the aorta and vena cava). Tumors located in the posterior (back) mediastinum can cause compression of the spinal cord.

Myasthenia gravis

Myasthenia gravis is an autoimmune disorder, characterized by weakness and rapid fatigue of any of the muscles under voluntary control. Around 10-15 percent of people with myasthenia gravis have thymoma. Another 60%, however, will have other abnormalities of the gland including thymic hyperplasia (an enlarged gland).

Thymectomy has been a mainstay in the surgical treatment of myasthenia gravis and helps over 85% of myasthenia gravis patients.

Thymoma

Thymoma is a tumor of thymus gland. Patients with thymoma may have other autoimmune disease (like myasthenia, pure red cell aplasia). Most of the patients don’t have any symptoms and the tumor is detected incidentally. Complete surgical removal helps long term cure to these patients. We offer key-hole surgery to these patients with excellent outcomes.

Esophagus

The esophagus or foodpipe is a muscular tube that moves food and liquid from the throat to the stomach.

Benign Esophageal Tumors

These are non cancerous tumors on the wall of the esophagus. These often go undetected until they grow large enough to make swallowing difficult. surgical excision of these tumors by minimal access techniques.

Esophageal Cancer

Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.. We also have state of art infrastructure and equipment required for disease evaluation and treatment. We use minimally invasive techniques to perform these surgeries.

Esophageal Cysts

May cause symptoms like difficulty in swallowing and problems with breathing. surgical excision of these tumors by minimal invasive methods

Esophageal Diverticula

Esophageal diverticula are small pouches that form in the esophagus.. Symptoms are difficulty swallowing, heartburn, regurgitation of food, hoarseness, repeated pneumonia, repeated episodes of inhaling food into airway or lungs, bad breath. Minimal invasive techniques are best suited for surgical excision

Airway (Trachea & Bronchus)

Tumors can block the airway and cause breathing problems. Most of the tumors that form in the trachea and bronchi in adults are cancerous, but a few are noncancerous .Treatment may include surgery, bronchoscopic treatments or radiation therapy, either alone or in combination. In patients who are not candidates for complete surgical removal of the tumor, these therapies may be used to help restore breathing and slow tumor progression. Other airway pathologies are tracheal stenosis, tracheobronchomalacia and tracheoesophageal fistula which require surgical management.

Pericardium

The pericardium is a thin sac that surrounds the heart. It protects the heart and provides the lubrication for the heart.

Pericardial window

A pericardial window is done to drain the excessive fluid around the heart. It can also help diagnose the source of the extra fluid. Conditions that might need a pericardial window include metastatic cancer,tuberculosis , renal failure Immune system disease with uremia

Diaphragm
  • Eventration & paralysis of diaphragm
    • The term ‘diaphragmatic eventration’ is used in common practice to describe a condition of relaxation of the diaphragmatic dome. It may present at birth or in a later stage of life as an acquired condition ‘acquired diaphragmatic paralysis’ or ‘acquired diaphragmatic elevation.
      Diaphragmatic hernia is an acquired condition when the abdominal contents breach to to reach hemithorax . these are caused by blunt abdominal trauma. Correction of defect by minimal invasive technique.
      The patients may experience respiratory symptoms such as breathlessness, cough or chest pain particularly on exertion. The goal of surgical correction is relieve compression on the lung parenchyma and allows its re-expansion Minimal access approach to these patients brings excellent outcomes.
Chest Wall

The chest wall is also known as thoracic wall, it is the boundary of the thoracic cavity

Tumors

Chest wall tumors may be malignant (cancerous) or benign (non-cancerous), and may originate there or have spread from elsewhere. Treatment can vary based on factors such as the type of tumor and the stage of its progression. Surgical resection is the mainstay of treatment for most early stage chest wall tumors.

Infections / sinuses

Chest wall infection may occur in soft tissue, cartilage and bone. Treatment depends on type location and magnitude of infection. Treatment may range from use of antibiotics to surgical resection of devitalized tissue and subsequent coverage with well vascularized soft tissue.

Endoscopic Thoracoscopic Sympathectomy

Endoscopic thoracic sympathectomy is used mainly as a treatment for excessive sweating (hyperhidrosis) but can also be used to help treat extreme facial flushing.

Axillary and Palmar hyperhidrosis

Hyperhidrosis is a condition characterized by abnormally increased sweating in excess of that required for regulation of body temperature. Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment. Endoscopic thoracic sympathectomy is of the chest which is offered to patients who have hyperhidrosis of underarms and hands or facial blushing. Surgery may be considered as a last resort of treatment.

Overview

Method of Operation

Traditionally thoracic surgeries were done by making big incisions over the chest, cutting all the muscles of the chest wall and applying a retractor to spread the ribs which causes bigger woundsand delayed recovery of the patient due to greater amount of pain leading to further complications. We specialise minimally invasive techniques which are Video Assisted Thoracoscopic Surgeries and robotic thoracic surgery.

  • Video-assisted thoracoscopic surgery / Thoracoscopy (VATS)
    • VATS is minimally invasive thoracic surgery performed by introducing a small camera and instruments through tiny cuts over the chest wall. VATS provides excellent visualization of the thorax, allowing the surgery to be performed even in sick and elderly patients who have marginal pulmonary reserve. Almost all operations in the chest can be done by this technique which avoids excessive pain and complications of open surgery. It also offers better cosmesis and the patient can return to work very soon after the surgery.
  • Robotic Thoracic Surgery
    • The latest cutting edge technology (da Vinci Xi robotic system) to provide the best outcome to our patients. The surgeon at the robotic console controls the robot to do the precise surgery of the patients along with all the benefits of minimally invasive surgery. Robotic technology provides highly magnified 3-D visualization and excellent dexterity by 7 degrees of freedom of robotic instruments which allow difficult dissections in narrow fields with better surgical ergonomics. This allows the surgeon to perform technically demanding complex operations with great precision and ease.
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