Thoracic surgery

Overview

Thoracic surgery encompasses a range of procedures performed within the chest or thorax. While the heart is the most well-known organ in this region, thoracic surgery also covers various other operations involving the lungs, esophagus, trachea, diaphragm, chest wall, and mediastinum.

These surgical interventions can be conducted using either open or minimally invasive techniques. In open surgery, larger incisions are made, whereas in minimally invasive procedures, surgeons make smaller incisions and utilize a video camera inserted into the chest.

During minimally invasive surgery, surgeons employ small, elongated instruments through these smaller incisions while using the video camera for guidance. They have specialized equipment and handheld video cameras designed for these procedures, which are often referred to as laparoscopic surgery for abdominal procedures or VATS (Video-Assisted Thoracic Surgery) for chest surgeries.

In some cases, surgeons may also utilize robotic-assisted techniques, where a robot assists in handling the instruments and camera, while the surgeon maintains precise control over these tools.

The two most common thoracic procedures are lobectomy, which involve removing a portion of the lung, and Coronary Artery Bypass Grafting (CABG).

Reasons for undergoing the procedure

Any procedure to address a problem with your chest or upper abdomen is referred to as thoracic surgery, and the conditions treated include:

• Congenital (present at birth) heart issues
• Coronary artery disease
• Heart or lung transplants
• Irregular heart rhythms
• Heart failure
• Heart valve issues
• Aneurysms
• Barrett’s esophagus
• Hiatal hernias
• Lung cancer
• Tumor in the thymus or esophagus
• Swallowing problem
• Gastroesophageal Reflux Disease (GERD)
• Tracheal stenosis
• Hyperhidrosis

Risks

Thoracic surgery risks include:

•  Blood clots
• Abnormal heart rhythms
• Heart failure
• Infections (e.g., pneumonia)
• Lung collapse
• Pulmonary edema
• Depression

Before the procedure

The necessity for blood testing prior to thoracic surgery can vary depending on the specific type of procedure you are undergoing. In addition to blood tests, cardiac evaluations for potential problems may involve various diagnostics such as imaging studies or assessments of heart rhythm and function.

For individuals with lung-related issues, a thorough diagnostic workup will typically include imaging studies and tests to assess pulmonary function. Additionally, doctors may employ various techniques to obtain tissue samples from the lungs for further evaluation. To gauge your risk of complications, your healthcare provider may also assess your physical fitness by having you perform activities such as walking up multiple flights of stairs or monitoring your endurance in a six-minute walk test.

Once all the necessary tests and evaluations are complete, a thoracic surgeon will review the results and subsequently schedule your surgical procedure accordingly.

You can assist yourself get ready for thoracic surgery by doing the following:

• Give up tobacco use at least one month before to lung surgery. This will lower your chance of wound complications in half, as will abstaining from tobacco use for one month following surgery.
• If your doctor advises you to stop taking any medications a few days prior to your operation, do so.
• Don’t forget to inform your provider about all medications you use, including over-the-counter ones. Wait to stop taking any medications until your doctor instructs you to.
• Request that a friend or relative drive you home and spend a few days with you.
• The night before or the day of operation, stop eating and drinking when instructed by your doctor.
• Meals should be prepared in advance and frozen to make things easier, as recovering from thoracic surgery will take time.
• Create a plan for your recovery.

During the procedure

After you are sedated with an intravenous (IV) anesthetic, a breathing tube will be inserted. The use of a machine to assist with your heart and lung functions during surgery may also be necessary, depending on the specific type of thoracic surgery you are undergoing.

Your surgeon is going to:

• Use conventional or minimally invasive methods to make the necessary incisions. To access the area, your surgeon may do a thoracotomy, or incision between your ribs, or a sternotomy, through your breastbone.
• Take care of the organ or bodily component that needs surgery, repair it, remove it, or replace it.
• Examine for bleeding.
• Seal off all cuts.

After the procedure

Following thoracic surgery:

• You will awaken in an intensive care unit or recovery room.
• Your breathing tube will be taken out by a doctor.
• It’s likely that you will have a catheter in your bladder to collect urine and tubes in your chest to provide drainage.
• Your doctor will transfer you to a standard hospital room whenever they determine you’re ready.
• You’ll walk with help through your room and hallway as soon as you’re able to.
• To assist in re-expanding your lungs, you can also practice breathing techniques.

You can typically be discharged and return home once you have met the goals and milestones set by your healthcare provider. The timing of your discharge will vary depending on the specific type of surgery, but it often occurs within a range of three to ten days after the procedure.

Outcome

The duration of your recovery following thoracic surgery is contingent upon the type of procedure you underwent. Hospital stays can last up to a week after thoracic surgery, while those who undergo minimally invasive procedures may recover in as little as three to four days. However, achieving full recovery may take a month or even longer.