General Thoracic Surgery
General Thoracic Surgery is surgery that involves the chest excluding the heart.
At Carson Surgical Group, we treat many diseases that affect the chest to include esophageal cancer, lung cancer, mediastinal tumors, pneumothorax (lung collapse), empyema (infections inside the chest cavity) and hyperhidrosis (excessive sweating in the palms and armpits). While many of these surgeries were traditionally done open, the majority of cases can now be treated with minimally invasive techniques.
The mediastinum is the term used to describe the center of the chest cavity. It can be broken up into Anterior (front), Middle, and Posterior (back).
Tumors that affect the Mediastinum are based upon the structures in that section. Anterior mediastinal tumors include the 4 “T’s”: Teratoma, Thymoma, Thyroid, and T-cell Lymphoma.
Middle mediastinal tumors are often tumors affecting the heart such as Atrial Mixoma. Posterior Mediastinal tumors includes paraganglionoma and Schwanoma to name a few. The traditional approach to these tumors has been from a Sternotomy (Opening the Breast plate as in a heart bypass surgery, or from a Thoracotomy (Opening on the side and spreading the ribs.) Now, nearly all of these tumors can be treated minimally invasively.
Pneumothorax is the collapse of the lung within the chest.
You can think of the lung like an inner tube contained within a tire (the chest wall). A Pneumothorax occurs when the lung (the inner tube) has a hole in it and collapses in the chest. This can occur in young patients as a result of “blebs” (blisters) on the lung that leak air into the chest. It can also occur in older patients, usually as a result of damage to the lung from smoking. Pneumothorax can almost always be treated with minimally invasive surgery.
Empyema (Pronounced: “M-Pi-E-Ma”)
Empyema is an infection that occurs between the lung and chest wall.
If we think again about the example of the inner tube and tire to represent the lung and the chest wall, an Empyema occurs when there is an infection that develops in the space between the lung (the inner tube) and the chest wall (the tire). This infection can progressively collapse the lung and cause severe illness and even death. Treatment of these infections is with surgery and antibiotics. Surgery can be very difficult and has often been done with an open thoracotomy (cutting into the side of the chest and spreading the ribs to access the chest cavity.) Within the last few years, advances in minimally invasive techniques and instrumentation has changed this surgery to a minimally invasive procedure.
According to the American Cancer Society, lung cancer is the second most common cause of cancer in Men (Prostate is number 1) and Women (Breast is number 1). About 13% of all new cancers are lung cancers. Approximately 228,150 new cases of lung cancer are diagnosed per year and approximately 142,670 deaths occur from lung cancer per year.
Treatment for lung cancer is based upon the stage of the cancer; the earlier the stage, the more likely that the patient can be cured. The best treatment for early stage lung cancer is surgery to remove the tumor. The surgery often involves removing a lobe of the lung (part of the lung) and the lymph nodes that drain that section of the lung. Rarely, the entire lung must be removed. Nearly all of the lung resections for cancer can now be done minimally invasively
VATS (Video Assisted Thoracic Surgery)
VATS is a type of thoracic surgery performed using a small video camera that is introduced into the patient’s chest via a scope. The surgeon is able to view instruments that are being used along with the anatomy on which the surgeon is operating. It is a minimally invasive surgical technique which can be used for many purposes, ranging from a biopsy to removal of tumors or entire lobes from the lung. VATS has revolutionized the treatment of diseases of the chest resulting in less pain, decreased hospital stays, and a more rapid recovery and return to normal activities.
Hyperhidrosis (Hi-per-hi-dro-sis) is a condition that causes excessive sweating. Palmar hyperhidrosis affects primarily the palms of the hands; however, most patients with hyperhidrosis also experience excessive sweating in the armpits and feet. This is not a common problem; affecting less than 1% of the population.
If you are one of the few individuals affected by this condition, you are all too aware of the severe disruption that can occur in your daily life as well as the embarrassment that you may suffer from excessive sweating. It is difficult for patients without hyperhidrosis to understand the concept of “excessive sweating”. Patients with hyperhidrosis can, literally, hold out their hand and watch their hand fill up with sweat or be forced to change their shirt 4 to 5 times per day because the shirt becomes drenched in sweat.
The cause of hyperhidrosis is not clear, but it is a disorder related to excessive activity on one side of the autonomic nervous system; the sympathetic nervous system. In brief, our brain and our body communicate using a set of “telephone wires”. We call this extensive system of wires and connections “the nervous system”. We have three nervous systems. There is the central nervous system (the brain its close connections), the peripheral nervous system (the nerves to and from the body) and the autonomic nervous system (the system that we do not control, but controls our body for us). The autonomic nervous system is broken down into the parasympathetic and sympathetic system. This all seems a bit complicated, but think about the concept of breathing which is regulated by the autonomic nervous system. You don’t have to think about breathing, it just happens. That is very convenient because if you had to tell yourself to breath every 12 seconds, there would not be much time left in the day to do anything else; not to mention that it would be difficult to sleep at night. The sympathetic nervous system is considered to be the “fight or flight” system. If you are scared, or hot, or in a hurry, this is the system that kicks in. Part of that response is sweating to cool down your body. In hyperhidrosis, the sympathetic nervous system is overactive and causes inappropriate and excessive sweating.
Hyperhidrosis causes abnormal and profound sweating. It can affect many areas of the body. These include:
- Palmar Hyperhidrosis: Palms of the hands
- Axillary Hyperhidrosis: Arm pits
- Plantar Hyperhidrosis: Bottoms of the feet.
As mentioned above, the excessive sweating can be embarrassing and socially debilitating. The symptoms usually start in adolescence. While the baseline sweating is profound, stress, emotions, and exercise can make it even worse.
Surgery is a definitive treatment. However, most patients will start with a visit to their primary doctor. They may also see a dermatologist. Non-surgical treatment options include oral or topical medications and antiperspirants. Many times, these treatments are not effective; however, it does help identify those patients who have severe hyperhidrosis and who will clearly benefit from surgery.
The current recognized standard of care for the surgical treatment of Hyperhidrosis is a Video Assisted Thoracic Surgery (VATS) bilateral sympathectomy. The sympathetic nervous system runs along the side of the spine in the chest. It is not part of the nervous system that runs in the spinal canal; the system that controls your body voluntarily. Disrupting the flow of information along this sympathetic nervous system chain by clipping the nerve is the only treatment with proven long-term results. Interrupting the sympathetic nerves in the chest results in the complete blockage of sweating.
This is a view inside the chest wall where the sympathetic chain runs along the front of the spine.
Video Assisted Thoracic Surgery (VATS) bilateral sympathectomy is a minimally invasive procedure that treats hyperhidrosis. Using small incisions, a camera is placed into the chest and a clip is placed on the sympathetic chain.
This eliminates the condition and the sweating stops immediately. This procedure is very effective with an extremely low complication rate and rapid recovery. Most patients leave the hospital in less than 24 hours and the recovery time is less than two weeks.