Diseases Diagnosed and Treated by Thoracic Surgery
• Chest wall (ribs, sternum / breastbone, muscles)
• Lungs
• Pleura (lung membrane)
• Mediastinum (tissues around the heart and main blood vessels, lymph nodes)
• Diaphragm
• Trachea
• Esophagus
Injuries
• Rib fractures
• Accumulation of blood and air in the chest cavity (hemo-pneumothorax)
• Lung, mediastinal, and airway injuries
Pneumothorax
• Accumulation of air in the chest cavity
Pleural Effusion
• Accumulation of fluid in the chest cavity
Excessive Sweating
• Excessive sweating in the hands and armpits (ETS)
Chest Wall Deformities
Pigeon chest: Outward protrusion of the ribs and breastbone
Funnel chest: Inward protrusion of the ribs and breastbone
Lung Cancers
• Cysts, abscesses, and other masses in the lungs
• Diseases of the lung membrane
• Infectious (inflammatory) diseases
• Tumoral diseases (mesothelioma)
• Mediastinal tumors, abscesses, and cystic diseases
• Tracheal stenosis and tumors
• Enlarged lymph nodes
Treatment Methods
VATS (Video-Assisted Thoracoscopic Surgery)
Areas of Application for VATS:
Most interventions typically performed via thoracotomy (open surgery) can be performed using VATS.
Features:
• Diagnosis and treatment of fluid accumulation in the chest cavity
• Diagnosis and treatment of masses in the lungs
• Treatment of excessive sweating (thoracic sympathectomy)
• Successfully used in the treatment of pneumothorax.
Video-Assisted Mediastinoscopy
Mediastinum: The central part of the chest cavity containing the trachea, esophagus, heart, major blood vessels, and lymph nodes.
Due to the surrounding bony and vascular structures, accessing this area externally is very difficult.
A small incision is made below the neck during mediastinoscopy, and this area is visualized using a camera system.
It is especially used for taking biopsies of lymph node enlargements or for the removal of certain lesions.
It is a minimally invasive method. The patient can be discharged within the first 24 hours after the operation or on the same day.
Bronchoscopy
Bronchoscopy is a procedure used to visualize the trachea (windpipe) and the airways of the lungs (bronchi) through the mouth or nose and to obtain biopsies and perform other interventions if necessary.
Since surgical incisions are not made and general anesthesia is not required, patients are discharged shortly after the procedure.
Diseases Treated Using Bronchoscopy
• Diagnosis of lung cancers
• Diagnosis and treatment of airway obstructions
• Used in cases of foreign body aspiration into the trachea and bronchi (e.g., needles, food particles, etc.)
In our clinic, an average of 350 surgeries are performed annually. A significant portion of these surgeries consist of lung cancer surgeries.
Video-assisted thoracoscopic and mediastinoscopic interventions also play a significant role in these surgeries.
Frequently Asked Questions
• What is a pneumothorax? What are its causes and how is it treated?
• Can lung cancer be treated with surgery?
• What should be done before surgery?
• What can patients expect after lung cancer surgery?
• What should be considered at home after surgery?
• When is the outpatient clinic follow-up conducted?
• What treatments are available for excessive sweating?
• What is ETS?
• Are there any side effects of ETS?
What is a Pneumothorax? What are its Causes and Treatment?
Pneumothorax is the accumulation of air in the chest cavity. The most common causes are trauma (stabbing, gunshot wounds, falls, blows, etc.) and spontaneous rupture of air cysts in the lungs due to structural defects or COPD. In its treatment, a plastic tube called a chest tube is used to evacuate the air from the chest cavity. If the disease recurs or improvement cannot be achieved using this method, surgical methods are employed.
Surgical Treatment of Pneumothorax
The primary choice for surgical treatment is a procedure called “video-assisted thoracoscopic surgery” (VATS). VATS is a closed surgery that is shorter in duration compared to open surgery, leaves minimal scarring, and results in much less postoperative pain. The patient's recovery and return to normal life are also shorter compared to open surgeries.
Lung Cancer Surgeries
Can lung cancer be treated with surgery?
Surgical resection is the most effective treatment method for lung cancer in its early stages, referred to as stages 1 and 2 (there are a total of 4 stages). The preferred treatment for lung tumors that have not spread to surrounding lymph nodes or distant organs (such as liver, brain, bone, etc.) is surgery. If the patient's general condition (heart-lung functions) can tolerate general anesthesia and the burden of removing a part of the lung, surgery remains the best treatment option and maintains its top priority.
What should be done before surgery?
First and foremost, smoking, the primary cause of lung cancer, should be stopped. Scientific studies have shown that quitting smoking even after the diagnosis of lung cancer has a positive effect on both life expectancy and quality of life. Balanced and regular nutrition, daily exercises (30 minutes of walking), and psychological support are crucial during this period. Chronic diseases such as diabetes, coronary artery disease, and COPD should be treated and monitored regularly, and communication should be established with the surgeon who will perform the surgery, providing information to the relevant doctor if necessary.
What can patients expect after lung cancer surgery?
During the early postoperative period, patients are promptly initiated with nutrition, respiratory therapies, and walking to quickly return to their normal lives (rehabilitation). The most common complaints of patients after surgery are usually pain at the operation site. Since this pain can be severe, it is controlled with very potent pain relievers or epidural analgesia. Besides pain, the most common problem is shortness of breath. As a part of the lung is removed during surgery, the workload of the heart-lung system increases, and respiratory difficulties may arise until the body's adaptation mechanisms come into play. If necessary, relief can be provided with oxygen therapy during this period and thereafter. Typically, patients monitored in the surgical intensive care unit for 1 night after surgery (with monitoring) stay in the hospital for an average of 5-7 days.
What should be considered at home after surgery?
Your doctor will prescribe the necessary medications (pain relievers, respiratory aids, etc.) during your discharge. Unless otherwise instructed by your doctor, continue to take the medications you were using before the surgery (for diabetes, COPD, heart, etc.) in the same way. Bathing is essential for body hygiene. You can take a shower one day after your chest tube is removed after surgery. However, do not rub the surgical area with cleaners such as loofah or scrub. Information regarding eating and drinking will be provided during your discharge. There is no special dietary regimen after lung surgeries. It is advisable to have frequent (5-6) and light meals, avoid carbonated beverages, alcohol, and excessively fatty and salty foods.
If sudden severe shortness of breath, copious amounts of foul-smelling and colored sputum, high fever, or fainting occurs at home, immediately go to our hospital's emergency department. The emergency physician will quickly communicate with the doctor who performed your surgery.
When is the outpatient clinic follow-up conducted?
The first outpatient clinic follow-up is scheduled for the first week after discharge. A appointment card indicating the day and time for your outpatient clinic follow-up will be given to you upon discharge. During the follow-up, your lung X-ray and physical examination will be evaluated. Additionally, your stitches will be removed during this check-up. The pathological evaluation of the tissues taken during surgery will also be reported during your follow-up. Your doctor will provide you with information regarding the subsequent process (follow-ups and treatments).
Surgical Treatment of Excessive Sweating (Thoracic Sympathectomy)
Excessive sweating, which can occur in the hands, face, armpits, and feet, is called "hyperhidrosis." It differs from general sweating seen throughout the body. Patients typically experience continuous sweating regardless of the season, whether it's summer or winter, in closed or open places. The most common complaint is excessive sweating in the hands and feet.
What treatments are available for excessive sweating in the hands?
Non-surgical treatments such as iontophoresis and botulinum toxin injections (performed by dermatologists) should be attempted first. If results cannot be achieved, surgical treatment, called "thoracoscopic sympathectomy," may be performed as a final option.
What is ETS?
Clipless ETS is the abbreviated term for the surgical treatment of excessive sweating (endoscopic thoracic sympathectomy). Under general anesthesia, the nerves responsible for sweating are identified by entering the chest cavity from both armpits. Nerve conduction is interrupted with 5 mm titanium clips. Blocking the t3 or t4 sympathetic ganglia is usually sufficient. The procedure takes about 1 hour. When the patient wakes up, sweating in the hands or armpits ceases.
Are there any side effects of ETS?
Postoperative chest pain is an expected condition. It develops due to the operation and decreases within 24-48 hours. Patients can return to their normal lives on the 2nd day. The most common side effect is often "reflex" sweating that occurs around the 1st week after surgery. Excessive sweating may develop in areas such as the back
, hips, groin, and knees, where sweating did not occur before. While this sweating may be temporary in some patients, it can be permanent in others. It can be a very frustrating condition for the patient. It is an unpredictable condition that arises from the sudden cessation of sweating in the previously excessively sweaty area of the body. Patients can have the clips placed on the nerves removed with a new operation. However, there is insufficient scientific data to determine whether the condition will return to normal or not.
