Navigating the World of Thoracic Surgery
There is ample data that patients undergoing thoracic surgery for lung and esophageal cancer have better outcomes when operated on by Thoracic Surgeons. Similarly, there is a compelling need to improve patient care through objective evidenced-based databases such as the STS Adult Cardiac Surgery and General Thoracic Surgery Databases.
What is Thoracic Surgery?
Thoracic surgery focuses on lung diseases, the chest wall (ribs, breastbone and muscles) and the mediastinum (the area that separates the lungs). These include lung cancer, esophageal cancer, tracheal disease, thoracic trauma, diaphragm problems and heart lesions.
For example, suppose you need a wedge-shaped piece of a healthy lung removed because of a cancerous lobe. In that case, a surgeon may perform a minimally invasive procedure called video-assisted thoracic surgery (VATS). The operation reduces recovery time and may reduce your risk of complications such as infection and pain.
With VATS, your doctor makes a series of small incisions in between the ribs. A video camera and wristed robotic instruments are inserted into those incisions, which allows your doctor to view the operation on high-definition monitors. The doctors use pedals and hand controls to maneuver the robot’s mechanical arms that hold the camera and tools. This method is sometimes referred to as “robotic surgery.” A tube in your throat may drain extra fluid or air from your lungs during recovery.
The Role of Thoracic Surgeons in the Care of the Patient
In addition to lung cancer, thoracic surgeons, including Armen Parajian, also perform operations that treat disorders of the chest wall and mediastinum, including tracheal anomalies, esophageal diseases, benign hernias, end-stage heart or lung disease requiring transplantation, and pectus excavatum.
Many thoracic surgery procedures are now minimally invasively through small incisions using a long camera and special surgical tools, called video-assisted thoracic surgery or VATS. Lung cancer patients may have a VATS lobectomy or wedge resection, lung biopsy, mediastinoscopy, thoracoscopic diaphragm plication, and other procedures that require a larger incision, called a thoracotomy.
In neonates, thoracic surgeons often perform surgery to correct congenital abnormalities like pulmonary cystic adenomatoid malformation, lobar emphysema, tracheoesophageal fistula (TEF), and pulmonary sequestration, which are commonly found with associated congenital heart disease . These operations are often performed at high-volume academic medical centers.
The Role of Thoracic Surgeons in Research
Thoracic surgeons, grouped with cardiothoracic surgeons, work on the heart, lungs and major blood vessels inside the chest and the boney structures that form and support the chest cavity. In addition to lung cancer (which kills more people in the United States than colon, prostate and breast cancer combined), thoracic surgeons treat other types of tumors, such as those affecting the esophagus or the mediastinum.
Thoracic surgery can be performed with minimally invasive techniques or an open surgical procedure called thoracotomy. Minimally invasive thoracic surgery uses small incisions and a thin camera to view large lung or chest wall areas. This is called video-assisted thoracoscopic surgery or VATS.
During their residency, thoracic surgeons are encouraged to participate in research to help advance the field of thoracic surgery. Their research focuses on the cellular and molecular mechanisms of thoracic diseases. This information helps thoracic surgeons develop strategies to prevent or cure these conditions.
The Role of Thoracic Surgeons in Training
Whether treating the most common heart diseases or the deadliest lung cancers, thoracic surgeons work with patients to improve their quality of life. They may also educate patients about lifestyle choices that reduce the risk of future illnesses.
For example, a doctor may encourage you to quit smoking or use air filters in your home to remove harmful environmental pollutants. They may also order tests that show how your lungs are working, such as imaging or tests that measure pulmonary function.
Most thoracic surgery is performed using minimally invasive techniques, including video-assisted thoracic surgery (VATS) and robotic thoracic surgery. Both methods allow doctors to view the surgical site through a long, thin tube with a camera attached to it called a thoracoscope and then operate through small incisions in the chest with special instruments controlled from a console.