Thoracic Surgery

Thoracic surgery is a significant surgical specialty that encompasses the surgical treatment of diseases of the lungs, mediastinum (the middle section of the chest cavity), chest wall, diaphragm, and esophagus. The Koru Hospital Department of Thoracic Surgery provides comprehensive surgical treatment services for chest region diseases with its advanced surgical equipment and experienced specialist staff.

Scope and Importance of Thoracic Surgery

Thoracic surgery deals with the surgical diseases of the lungs, which are vital organs, and other structures within the chest cavity. Thoracic surgeons perform surgical treatments for many benign and malignant diseases, primarily lung cancer. Today, with the development of minimally invasive surgical techniques, significant progress has been made in the field of thoracic surgery.

Lung cancer is the most common cause of cancer-related deaths worldwide. Surgical treatment at an early stage provides the highest chance of recovery in lung cancer. Therefore, thoracic surgery constitutes a critical component of the oncological treatment process.

Lung Cancer and Its Surgical Treatment

Lung cancer is one of the most common types of cancer in both men and women. Smoking is the most important risk factor; however, it can also develop in non-smokers. Chronic cough, bloody sputum, shortness of breath, chest pain, hoarseness, and unexplained weight loss are the primary symptoms.

In the surgical treatment of lung cancer, the size, location, and stage of the tumor are decisive:

• Wedge resection: The removal of a small piece of the lung where the tumor is located. It is preferred for small, early-stage tumors.
• Segmentectomy: The removal of a segment of the lung. It may be preferred in patients with limited lung function.
• Lobectomy: The removal of an entire lobe of the lung. It is the most commonly applied standard method in lung cancer surgery.
• Pneumonectomy: The removal of an entire lung. It may be necessary depending on the extent of the tumor.

Mediastinal lymph node dissection is also an important part of the surgery in lung cancer. Pathological evaluation of lymph nodes plays a critical role in staging the disease and determining the treatment plan.

Video-Assisted Thoracoscopic Surgery (VATS)

Video-assisted thoracoscopic surgery (VATS) is a revolutionary development in thoracic surgery. This minimally invasive method, performed by making small incisions in the chest wall with the help of a camera and special instruments, offers many advantages compared to traditional open surgery (thoracotomy).

• Less postoperative pain and reduced need for analgesics
• Smaller scars and better cosmetic results
• Shorter hospital stay
• Faster recovery and return to daily life
• Lower risk of postoperative complications
• Better preservation of lung functions

Lung cancer surgeries, lung biopsies, treatment of pleural diseases, removal of mediastinal tumors, and treatment of pneumothorax are successfully performed using the VATS method.

Mediastinal Diseases and Surgery

The mediastinum is the middle section of the chest cavity between the two lungs. The heart, major blood vessels, trachea, esophagus, thymus gland, and various lymph nodes are located in this region. Tumors and cysts that develop in the mediastinum are an important area of interest for thoracic surgery.

• Thymoma: Tumors originating from the thymus gland. It may be associated with myasthenia gravis. Surgical removal forms the basis of treatment.
• Lymphoma: Lymphomas originating from mediastinal lymph nodes are common. Biopsy is required for diagnosis.
• Neurogenic tumors: Tumors originating from nerve tissue in the posterior mediastinum.
• Germ cell tumors: Rare tumors that can develop in the anterior mediastinum.
• Bronchogenic and pericardial cysts: Benign cystic lesions that develop in the mediastinum.

Pleural Diseases

The pleura is the thin, membrane-like structure that covers the lungs and the inner surface of the chest wall. Pleural diseases are frequently encountered conditions in thoracic surgery practice.

Pleural effusion (fluid accumulation in the lung membrane) can develop due to various reasons. Infections, heart failure, liver diseases, and cancers are among the most common causes. Fluid analysis is performed via diagnostic thoracentesis. For recurrent effusions, pleurodesis (adhesion of the pleural layers) or the placement of a tunneled catheter may be applied.

Empyema (pus accumulation in the pleural space) usually develops as a complication of pneumonia. Treatment may involve drainage via tube thoracostomy, decortication via VATS, or decortication via open surgery.

Malignant pleural mesothelioma is an aggressive type of cancer associated with asbestos exposure. A combination of surgery, chemotherapy, and radiotherapy is applied in the treatment.

Pneumothorax

Pneumothorax is the condition of air accumulation in the space between the lung and the chest wall. It causes the lung to collapse and may require emergency intervention. Spontaneous pneumothorax is usually seen in young, tall, and thin men. Traumatic pneumothorax, on the other hand, develops as a result of chest trauma.

Depending on the severity of the condition, observation, needle aspiration, tube thoracostomy, or surgical intervention is applied in the treatment. In recurrent pneumothorax, bullectomy and pleurodesis via VATS are performed to prevent recurrence.

Chest Wall Diseases

Chest wall deformities and tumors fall within the scope of thoracic surgery:

• Pectus excavatum (funnel chest): The inward depression of the anterior chest wall. Surgical correction may be required in severe cases. The Nuss procedure is a minimally invasive treatment method.
• Pectus carinatum (pigeon chest): The outward protrusion of the anterior chest wall. Orthotic treatment or surgical correction can be applied.
• Chest wall tumors: Benign or malignant tumors originating from bone, cartilage, or soft tissue. Surgical resection and reconstruction form the basis of treatment.

Tracheal Diseases

Tracheal (windpipe) diseases are rare but serious conditions. Tracheal stenosis, tracheal tumors, and tracheoesophageal fistulas are among the diseases treated in thoracic surgery. Tracheal stenosis resulting from long-term intubation or tracheostomy is the most common cause. Endoscopic dilatation, laser therapy, stent placement, or surgical resection and end-to-end anastomosis can be applied in the treatment.

Hyperhidrosis (Excessive Sweating) Treatment

Hyperhidrosis is a condition of excessive sweating in the hands, feet, underarms, or facial area. Thoracic surgery plays an important role in the treatment of this condition, which significantly affects social and professional life. The thoracoscopic sympathectomy surgery provides a permanent solution by cutting the nerves that trigger sweating. This surgery, performed via the VATS method, is minimally invasive, and patients can return to their daily lives in a short time.

Surgical Treatment of Lung Metastases

Cancers in other organs can spread to the lungs. Colorectal cancer, kidney cancer, breast cancer, and soft tissue sarcomas are among the tumors that most frequently metastasize to the lungs. In suitable patients, the metastasectomy (removal of metastases) operation can significantly increase survival. In these operations performed with VATS or open surgical methods, coordinated work with the oncology team is of great importance.

Diagnostic Methods

Various methods are used in the diagnostic process in thoracic surgery:

• Computed tomography (CT): The primary imaging method for evaluating chest diseases.
• PET-CT: Used in cancer staging and evaluating treatment response.
• Bronchoscopy: Endoscopic visualization of the airways and taking biopsies.
• Mediastinoscopy: A surgical diagnostic method applied for the evaluation of mediastinal lymph nodes.
• VATS biopsy: Taking tissue samples for diagnostic purposes from lung or pleural lesions.
• Fine-needle aspiration biopsy: Taking tissue samples from lung lesions under CT guidance.
• Pulmonary function tests: Evaluation of lung capacity before surgery.

Postoperative Process and Rehabilitation

Close follow-up of patients after thoracic surgery is of great importance. Chest tube care, pain control, respiratory physiotherapy, and early mobilization are the fundamental elements of the recovery process. Pulmonary rehabilitation programs play a critical role in regaining respiratory capacity, especially in patients who have undergone lung resection.

In the Koru Hospital Thoracic Surgery department, our specialist physicians provide safe and effective healthcare services to our patients in the surgical treatment of chest region diseases with the most current surgical techniques and a multidisciplinary approach.