Thoracic Surgery

The chest, or thorax, holds the organs of breathing and the passage of food, wrapped around the heart and its great vessels. Thoracic surgery looks after all of these structures except the heart itself, which belongs to cardiac surgery. Its scope includes the lungs and the bronchi, the smooth pleural membranes around them, the windpipe, the esophagus, the mediastinum (the central compartment between the two lungs that contains the thymus, lymph nodes and great vessels), the bony and muscular chest wall and the diaphragm beneath. The same team that removes a lung tumour may also drain an infected chest, repair a chest wall deformity, take out an enlarged thymus or rebuild a damaged airway, because all of these share the same anatomy and the same surgical approaches.

Lung and airway work covers lung cancer and tumours that have spread to the lung from elsewhere, a collapsed lung (pneumothorax) from a ruptured air sac or injury, severe emphysema treated by lung volume reduction, lung infections such as bronchiectasis, certain lung cysts including hydatid cyst, and disease of the windpipe. Pleural surgery treats infection and pus in the chest (empyema), fluid collections and tumours of the pleural lining such as mesothelioma. Esophageal surgery addresses cancer, diverticula, certain hernias and swallowing disorders. Mediastinal and thymic surgery removes tumours and cysts in the centre of the chest, including thymoma, and performs thymectomy as part of the treatment of the autoimmune condition myasthenia gravis. Chest wall and diaphragm surgery corrects deformities such as a sunken or protruding breastbone, repairs the diaphragm and treats chest injuries. A further small but life-changing area is surgery for severe sweating of the hands and underarms.

Most lung cancer surgery removes the affected part of the lung, ranging from a small wedge or a single segment to a whole lobe (lobectomy) and, rarely, an entire lung, together with the nearby lymph nodes for accurate staging. Wherever the disease allows, this is done by video-assisted thoracic surgery, in which a camera and slim instruments pass through a few short cuts between the ribs, or by robotic surgery, which adds wristed instruments and a magnified three dimensional view. Both spare the spreading of the ribs that open surgery requires, so there is usually less pain, less blood loss and a quicker return to normal life. Open surgery remains the right choice for large or advanced tumours and for some reconstructions. Other common operations include drainage and decortication for an infected chest, removal of mediastinal and thymic masses, esophageal and tracheal surgery, repair of chest wall deformities, and endoscopic surgery to interrupt the nerve that drives excessive sweating.

A clear diagnosis comes before any operation. Imaging with chest x ray, computed tomography (CT) and, for cancer, PET-CT shows the size, position and spread of disease, while breathing tests confirm that the lungs can tolerate surgery. Tissue samples are often needed and can be taken through the airway by bronchoscopy, from the lymph nodes of the mediastinum by mediastinoscopy or endobronchial ultrasound, or from the esophagus by endoscopy. In the operating theatre, high definition cameras, robotic platforms and energy devices that seal tissue without sutures make precise, minimally invasive work possible. Because lung and esophageal cancer are staged and treated by a team, the surgeon plans each case together with pulmonology, medical and radiation oncology, radiology, pathology and intensive care, so that surgery fits into one coherent overall plan.

For people travelling from abroad, the journey usually begins remotely: your scans, biopsy results and medical history are reviewed so that a provisional plan and a realistic idea of the operation and recovery can be shared before you arrive. On arrival, an in person assessment and any remaining tests, such as breathing tests, blood work and updated imaging, confirm the plan. Keyhole lung surgery typically means a hospital stay of about 2 to 5 days, with a chest drain removed once the lung has sealed and re-expanded; major open or esophageal operations need longer in hospital and a more gradual recovery. Most patients are advised to stay in the destination area for one to a few weeks after discharge so wounds can be checked, the chest drain managed and fitness to fly confirmed, since air travel too soon after chest surgery carries a risk. Interpreter and international patient services help with appointments, consent and day to day questions, and your team will arrange remote follow up once you are home.