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Overview

The human body is an extremely complex machine where each and every organ has not just its own function, but also a fixed position with respect to others. The overall arrangement is impeccable and efficient to the max, with proper protection for all the delicate organs. Generally, this protection is provided by the different structures formed by the arrangements of the bones; for example, the abdominal cavity protects the stomach and other organs, the thoracic cavity protects the heart, lungs and such.

 

Let us take a deeper look at the thoracic cavity. It is outlined by the thoracic wall that constitutes of not just the rib cage (bone structure) but also the skin, tissues, and muscle – all coming together to protect a number of delicate and critical organs
  • The Heart
  • The blood vessels including the aorta and the pulmonary artery
  • The inferior and superior vena cava
  • The lungs
  • The diaphragm
  • The trachea
  • The oesophagus
  • The endocrine glands like the thymus gland

Looking at the above list, which is not even exhaustive, we can appreciate the importance of the thoracic cavity and the criticality of maintaining it. The branch of medicine dealing with the study of thoracic organs is known as cardiothoracic studies.

The branch of surgery dealing with the surgical procedures of organs inside the chest is referred to as Thoracic surgery. But, this does not include the surgery of heart or the great blood vessels – aorta and the pulmonary artery. That is a specialized field of study undertaken by cardiac surgeons.

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The diseases that are in the purview of the thoracic surgery are

  • Chest Wall Tumour
  • Congenital Lung Malformation
  • COPD
  • Cystic Fibrosis
  • Emphysema
  • Endobronchial Tumour
  • Esophageal Cancer
  • Lung Cancer
  • Pulmonary Fibrosis
  • Shortness of Breath among others

As is evident, these diseases are some of the most severe ones and hence require a specialist for their identification as well as treatment. The doctors who specialize in surgeries of the organs in the thoracic cavity are known as Thoracic Surgeons.

Among the multitude of surgeries that a thoracic surgeon performs, some of the most common ones are

  • Airway reconstruction
  • Bronchoscopy
  • Chest Wall Resection
  • Diaphragm Plication
  • Esophagectomy
  • Lung Cancer Screening
  • Lung Transplant
  • Pneumonectomy
  • Tracheostomy
  • Video Assisted Thoracoscopy (VATS)

In this article, we will take a closer look at two of the procedures – VATS and Tracheostomy.

Video Assisted Thoracoscopy

The Video Assisted Thoracoscopy is a minimally invasive surgery performed by the Thoracic Surgeons for a number of diseases.

During a VATS, the thoracic surgeon makes small incisions in the chest wall among the ribs. An extremely tiny video camera, also known as thoracoscope, is inserted into the rib cage via these incisions. This video camera then provides live images of the inside of the chest, which guides the surgeon performing the Video assisted thoracoscopy.

Being a minimally invasive procedure, VATS has several advantages over the more traditional approach to Thoracic Surgery. Since the incisions are really small and tiny instruments are used to perform the surgery, with robotic precision, rather than opening up the thoracic cavity; the process and the recovery period is shorter and less painful.

Even though VATS is considered less painful and faster in recovery, it does not mean that the procedure does not have its own inherent risks. Like any other involved and complex medical procedure, the video assisted thoracoscopic surgery (VATS) has its own set of associated risks. Some of the risks include

  • Infection, sometimes leading to pneumonia
  • Reaction or allergy to the general anaesthetic being used
  • Excessive bleeding, during or after the surgery
  • Minor or major nerve damage

Tracheostomy

The second thoracic surgery procedure that we look into is Tracheostomy. It literally means, an artificial hole created in the windpipe (trachea) of a human being, so as to assist in normal breathing, in case the actual breathing is blocked due to any circumstances. The most common example of people needing a tracheostomy are those, who have been on artificial respiratory support (e.g. Ventilators) for a long time – typically more than two weeks. A situation may arise, where the thoracic surgeon may need to perform an emergency tracheostomy, for example in case of an accident.

Once the requirement for the tracheostomy is over, it is allowed to heal naturally or closed by means of a surgery. There may be situations or cases, where the hole needs to be allowed to remain permanently.

Like with any other medical procedure or other video assisted thoracoscopic surgery, tracheostomy also has its own set of risks, which need to be borne in mind before going for the procedure. If you have any concerns regarding the planned thoracic surgery, ensure to get the same clarified by your doctor. Some of the most common risks associated with the Tracheostomy procedure include

  • Temporary or permanent damage to the trachea
  • Hematoma causing breathing difficulties
  • Subcutaneous Emphysema
  • Excessive Bleeding

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