BAGHAI THORACIC SURGEON

FIROOZGAR HOSPITAL

THORACIC SURGERY

Field of General Thoracic Surgery

Chest wallPleural spaceLung Airways MediastinumEsophagus DiaphragmPericardium

Chest wall

Chest wall deformitiesChest wall tumorsThoracic outlet syndromeInfections of the chest wallHyperhydrosis( thoracic sympathectomy)Anterior transthoracic approaches to the

spineChest wall radiation necrosis( chest wall

reconstruction)

Pleural space

Empyema PneumothoraxPleural effusionChylothoraxMalignant mesothelioma

Lung

Congenital lesions of the lungBacterial infectionsPulmonary tuberculosisHydatid disease of the lungLung cancer and other tumorsSolitary pulmonary noduleLung transplantation

Airways

Nonneoplastic diseases of the trachea ( post intubation tracheal stenosis)

Benign and malignant tumors of the trachea ( squamous cell carcinoma, adenoid cystic

carcinoma, carcinoid tumor)Tracheal metastatic tumorCompression of trachea by vascular ring & other congenital anomalies( complete

tracheal rings)Tracheostomy

Mediastinum

Thymus gland ( tumors, myasthenia gravis)Mediastinal parathyroidsAcute and chronic mediastinal infections ( descending necrotizing mediastinitis)Primary mediastinal tumors and cystsMediastinal lymphadenopathies

Esopahgus

Trauma ( foreign bodies, esophageal burn, perforations)

Congenital anomaliesGastroesophageal refluxMotility disordersEsophageal diverticulaTumors ( benign and malignant tumors)

Diaphragm

Diaphragmatic hernias ( Buchdalek, Morgagni and paraesophageal)

Trauma and rupture of diaphragmTumors of diaphragmDiaphragmatic eventration and paralysis

( pacing of the diaphragm)

Pericardium

Pericardial effusions and cardiac temponade

Principles of thoracic surgery

Anatomic considerationNegative pressure of pleural space AnesthesiaLung functional capacities FEV1, VC, MVV Po2, Pco2, Dlco, Max O2 consumption

Physiologic considerationpulmonary physiologic assessment of operative risk

Pco2<45 mmHgDLco>60%Patient physical activity : climb 1-2 flights

of stairsPostoperative predicted FEV1Quantitative ventilation perfusion scanExercise testing : Max.O2 consumption>15 ml/kg/min predicted postop.Max O2 consumption>10

Diagnostic Procedures

Surgical pathology

Pleural biopsyTransbronchial biopsyLung (transthoracic) needle biopsyOpen lung biopsySegmentectomyLobectomyPneumonectomy

Cytology

Pleural fluidSputumBronchoalveolar lavageBronchial brushingLung fine-needle aspiration

Bronchoscopic Evaluation of the Lungs and

Tracheobronchial Tree

RIGID BRONCHOSCOPY

Foreign body removalMassive hemoptysisInfant endoscopyDilation of stricturesTracheal obstructionLaser bronchoscopy

Flexible Fiberoptic Bronchoscopy

Patient comfortSegmental visualizationSegmental biopsyPeripheral biopsyTransbronchial needle aspirationBedside aspirationBronchoscopy on ventilatorPhotographyIncreased cancer diagnosisBrachytherapyLaser bronchoscopy

Invasive Diagnostic Procedures

MEDIASTINOSCOPYScalene BiopsyTHORACENTESISNEEDLE BIOPSY OFTHE PLEURA

Video-Assisted Thoracic Surgery as

a Diagnostic Tool

Pleural EffusionMesotheliomaDiffuse Interstitial Lung DiseaseSolitary Lung NodulesLung Cancer StagingMediastinal DiseaseChest Trauma

Surgical approach to the chest

Incisions : Posterolateral thoracotomy incision Lateral thoracotomy incision Anterolateral thoracotomy incision Median sternotomy Clamshell incision Trapdoor incision Thoracoscopic approach

Technological progress

Video assisted thoracoscopic surgeryFiberoptic bronchoscopyVideo assisted mediastinoscopyImaging CT scan, MRI, Pet Scan, Dye studies,

isotope scan, ultrasonographyStaplers Medications , lung transplantation

Pain control : epidural analgesia, patient control analgesia, intercostal nerve block, TENS,….

Chest physiotherapy, bronchoscopy, tracheostomy

Anesthesia:Double lumen endotracheal tube, Intensive care

ONE LIMB IS PROGRESS IN THE SAME DIRECTION AS BEFORE

ANOTHER LIMB IS PROGRESS IN AN UNUSUAL DIRECTION

Future ?