Thoracic surgery is a medical specialty that deals with surgical diseases of the organs located within the chest cavity, including the lungs, esophagus, chest wall, diaphragm and the mediastinum, which is the central region behind the lungs. Today, thoracic surgery aims to improve patients’ quality of life not only through open surgery but also by using minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) and robotic surgery.
What Is Thoracic Surgery?
Thoracic surgery encompasses the surgical procedures required for the organs located within the thoracic cavity, the region between the neck and the abdominal cavity. The aim is to correct both functional and structural disorders of the chest cavity. The primary focus of thoracic surgery is often the lung tissue; however, it encompasses all intrathoracic structures except the heart. Operations involving the heart and major blood vessels fall under the specialty of ‘Cardiovascular Surgery’.
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What Diseases Does Thoracic Surgery Deal With?
Thoracic surgery is responsible for the diagnosis and treatment of a wide range of diseases, both benign and malignant. The diseases managed by thoracic surgery department are listed below:
- Lung cancer: It is the surgical removal of primary lung tumors (lobectomy or pneumonectomy).
- Collapsed lung (Pneumothorax): It is the collapse of the lung due to air accumulation in the pleural cavity.
- Thoracic wall deformities: It includes chest wall deformities commonly known as Shoemaker's chest (pectus excavatum) or pigeon chest (pectus carinatum).
- Excessive hand and armpit sweating (Hyperhydrosis): They are cases of excessive sweating treated using the clip-based ETS method.
- Esophageal diseases: Includes esophagus cancers, esophageal stenoses or diverticula.
- Mediastinal tumors: They are masses located in the area between the two lungs (thymoma etc.).
- Pleura fluid accumulation (Pleural effusion): It includes fluid emptying procedures for diagnosis or treatment.
- Chest traumas: They include all rib fractures and internal organ injuries resulting from accidents or trauma.
- Pleural diseases: They include diseases such as pleural cancer (mesothelioma), fluid accumulation in the chest cavity (pleural effusion) and pleural infections (empyema).
What Are The Diagnostic Methods Used In Thoracic Surgery?
Thoracic surgery utilizes advanced imaging technologies to establish a final diagnosis and plan surgical treatment. The diagnostic process is carried out to support physical examination findings, determine the stage of the disease and assess the patient’s suitability for surgery prior to intervention. Accurate diagnosis is the first and most important step for surgical success. The fundamental diagnosis methods used in thoracic surgery as follows.
- Lung X-ray: It is generally the first-choice diagnostic method and shows the overall structure of the heart and lungs, fluid accumulation and large masses.
- Computed Tomography (CT): It allows high-resolution sectional imaging of thoracic tissues and provides detailed information about vascular structures and lymph node involvement.
- Positron Emission Tomography (PET-CT): It evaluates metabolic activity in the body to help determine whether a mass is likely benign or malignant.
- Magnetic Resonance Imaging (MRI): It is used especially to evaluate vascular and nerve involvement as well as chest wall invasion.
- Spirometry: It is a basic test that measures how quickly and how much air a patient can exhale after taking a deep breath.
- Diffusion Capacity (DLCO): It analyzes how efficiently oxygen is transferred from the lungs into the bloodstream.
- Artery Blood Gas Analysis: It directly measures the levels of oxygen and carbon dioxide dissolved in the blood.
- Bronchoscopy: It is the procedure of visually examining the airways from the inside using a thin, lighted tube (a bronchoscope) and taking biopsies.
- EBUS (Endobronchial Ultrasonography): It enables needle biopsy of lymph nodes outside the airways using an ultrasound device attached to the tip of the bronchoscope.
- EUS (Endofacial Ultrasonography): It is the examination of tissues within the chest by accessing them through the esophagus.
- Mediastinoscopy: It is the sampling of lymph nodes between the lungs by making a small incision over the chest bone (sternum).
- VATS (Video Assisted Thoracoscopy): It is a minimally invasive surgical technique in which a camera is used to enter the chest cavity and obtain large tissue samples from the pleura or lung.
- Thoracentesis: It is the removal of fluid accumulated between the pleural membranes using a needle, followed by laboratory analysis.
Who Are Under Risk During The Thoracic Surgery Diagnostic Process?
Every surgical or interventional diagnostic procedure may carry certain risks depending on the patient’s overall health condition. Before requesting these tests, the specialist evaluates the patient’s chronic diseases and risk factors. Risk groups that need to be followed-up with care are listed below:
- People with low lung reserve due to advanced age
- People with uncontrolled heart failure and severe coronary artery disease
- Patients with high risk of bleeding due to blood thinner medication usage
- Severe COPD or emphysema patients
What Should Be Kept In Mind Before And After Thoracic Surgery Test And Diagnostic Methods?
The pre-procedure preparation process is of great importance for the success of diagnostic methods and the patient’s comfort. Since most interventional procedures are performed under sedation or general anesthesia, preparation protocols must be followed.
Before the procedure:
- Fasting for at least 6-8 hours before the procedure is usually required.
- Medications (especially those for diabetes and hypertension) should be adjusted in consultation with the physician.
After the procedure:
- The patient is kept under observation in the hospital until the effects of anesthesia wear off.
- Temporary symptoms like cough or slight burning in throat can be accepted as normal.
- In cases of fever, severe shortness of breath or bloody sputum, medical attention should be sought immediately without delay.
In What Situations Should Thoracic Surgery Be Consulted?
Some symptoms may indicate a surgical problem involving the organs within the chest cavity. In cases of long-lasting and persistent symptoms, seeking the opinion of a specialist surgeon is of vital importance. Symptoms that require thoracic surgery examination are as follows:
- Persistent and bloody cough (hemoptysis)
- Stinging chest pain while taking a deep breath
- Unexplained shortness of breath
- Palpable swelling or deformity in chest wall
- Swallowing difficulty or feeling like food is getting stuck in throat
What Is The Difference Between Thoracic Surgery And Thoracic Diseases?
While the thoracic diseases department focuses on medical (non-surgical) treatment and follow-up care, thoracic surgery deals with structural or tumor-related conditions that require surgical intervention.
What Treatment Methods Are Used In Thoracic Surgery Department?
Thoracic surgery is a medical specialty that involves the surgical treatment of organs within the chest cavity (thorax), primarily the lungs. The treatment methods applied in this department vary depending on the type and stage of the disease, as well as the patient’s overall condition. In thoracic surgery, the treatment approach requires a multidisciplinary planning process. Surgical methods are often combined with medical treatments (chemotherapy and radiotherapy). The aim is to completely eliminate the disease, stop its progression or improve the patient’s quality of life.
Open Surgery (Thoracotomy)
It is the classic method performed by surgically opening the chest wall. It provides a wide field of view but the recovery time is longer compared to other methods. Thoracotomy may be preferred in the treatment of diseases below:
- Large tumors
- Advanced stage lung cancer
- Complex cases
Minimally Invasive Surgical Methods
They are modern surgical techniques performed through smaller incisions and include the following methods:
- Video Assisted Thoracoscopic Surgery (VATS): It is performed using a camera and specialized surgical instruments. Pain, hospital stay time and recovery time are shorter compared to open surgical methods.
- Robotic Surgery: It is an advanced minimally invasive surgical technique performed using robotic systems. It offers high precision and a lower risk of complications.
Lung Resections
It is the removal of the diseased part of the lung tissue. It is commonly performed for lung cancer and certain infections and includes the following procedures:
- Lobectomy: It is the removal of a lobe of the lung.
- Pneumonectomy: It is the complete removal of lung.
- Segmentectomy / Wedge resection: It is the removal of smaller portions of lung tissue.
Surgery of Pleural Diseases
It is used in diseases of the pleura, the membrane surrounding the lungs and includes the following procedures:
- Emptying of pleural effusion (fluid accumulation)
- Pleurodesis (procedure of preventing fluid recurrence)
- Pleura biopsy
Mediastinum Surgery
It is the treatment of diseases in the mediastinum, the area between the lungs. It includes thymus gland diseases, lymph node biopsies and mass removal procedures.
Thoracic Wall Surgery
It includes procedures involving the bones and soft tissues that make up the chest wall. It includes the removal of chest wall tumors, post-traumatic repairs and corrective surgery for congenital deformities.
Trachea And Bronchus Surgery
It is used in the treatment of airway narrowing or tumors. Tracheal (windpipe) stenosis and bronchial tumors are treated using this method.
Lung Transplantation
It is used in advanced-stage lung diseases such as COPD, pulmonary fibrosis and cystic fibrosis. In suitable patients, it can significantly improve both life expectancy and quality of life.
Diagnostic and Interventional Procedures
It is performed to establish a diagnosis or determine the stage of a disease. Includes bronchoscopy, biopsy and thoracentesis procedures.
