Thoracic surgery

Thoracic surgery is responsible for treating diseases and injuries which affect the rib cage and its organs, excluding the heart, aorta and oesophagus. Pulmonary transplants come under the competency of university hospitals.

Fields covered by thoracic surgeons

Strictly speaking, these fields involve the diagnosis and surgical treatment of traumas and diseases relating to the lungs, the rib cage and the mediastinum. In particular, these include cancers (lung cancer is the deadliest oncological disease worldwide), pulmonary metastases, emphysema, lung abscesses, diseases of the pleura, and thoracic deformities and malformations (pectus carinatum, pectus excavatum).

For example:

- For thoracic traumas, the surgeon must sometimes stabilise multiple rib fractures or a flail chest.

- Pleural surgery relates to pleural effusions and pneumothorax: talcage, decortication and pleurodesis. An endoscopic thoracic sympathectomy can be indicated to treat excessive sweating of the hands.

- A mediastinoscopy allows biopsies to be taken from enlarged ganglia or suspicious masses.

- Pulmonary lesions are treated with a simple exeresis (wedge resection), a segmentectomy, lobectomy or bilobectomy, or even a pneumonectomy. These procedures can be combined with chest wall reconstructions and resection and anastomosis of the bronchus and/or artery. Cancer is the number one pathology treated; full surgery, if possible, remains the only curative treatment. Metastases, such as colorectal cancer, are also treated.

Techniques used

Thanks to constant improvements in medicine and surgery, today thoracic surgeons are able to use modern techniques such as laser surgery and a minimally invasive thoracic surgery known as a thoracoscopy (also called “keyhole surgery”).

Thoracoscopy

This minimally invasive approach allows the surgeon to access the thoracic cavity using a small camera and long, narrow surgical instruments. The operation requires several, small, 2 cm incisions. This technique is currently used to treat a number of conditions. It leaves only minimal scarring. It has the shortest period of hospitalisation, and there is less postoperative pain than if the same surgical procedures were carried out conventionally.

However, sometimes more traditional techniques must be used.

Thoracotomy

This is a kind of surgical procedure used to open the rib cage using a long incision between two ribs. It is used in some major operations. The mobility of the shoulder and arm is not affected, and the incision is not incapacitating. Before the procedure, it is generally beneficial to administer a local anaesthesia using an epidural catheter. The pain experienced after the operation is comparable to that of a broken rib. There may be some discomfort around the part of the chest wall that has been operated on, but this will disappear after a few weeks.

Sternotomy

This is a surgical operation which opens the sternum, the flat bone in the centre of the rib cage that is attached to the ribs. This procedure gives the surgeon access to the mediastinal area near the heart. It also enables them, for example, to carry out a thymectomy in the case of pathologies which affect the thymus. At the end of the operation, the two parts of the sternum are reattached using metal wires. This operation is generally well tolerated, and patients can resume physical activity in approximately two months.

Thoracic drainage

After any surgical incision to the thorax, one or two drainage tubes are inserted into the thoracic cavity to drain residual liquid and air. They are normally removed after a few days.

The thoracic surgery department works closely with other departments

  • the pulmonology department – investigation and postoperative follow-up
  • the anaesthesia department 
  • the interventional radiology department
  • the oncology department
  • the respiratory physiotherapy centre

Finally, a fully equipped technological environment is needed to carry out thoracic surgery.