baghai thoracic surgeon firoozgar hospital thoracic surgery
TRANSCRIPT
BAGHAI THORACIC SURGEON
FIROOZGAR HOSPITAL
THORACIC SURGERY
Field of General Thoracic Surgery
Chest wallPleural spaceLung Airways MediastinumEsophagus DiaphragmPericardium
Chest wall
Chest wall deformitiesChest wall tumorsThoracic outlet syndromeInfections of the chest wallHyperhydrosis( thoracic sympathectomy)Anterior transthoracic approaches to the
spineChest wall radiation necrosis( chest wall
reconstruction)
Pleural space
Empyema PneumothoraxPleural effusionChylothoraxMalignant mesothelioma
Lung
Congenital lesions of the lungBacterial infectionsPulmonary tuberculosisHydatid disease of the lungLung cancer and other tumorsSolitary pulmonary noduleLung transplantation
Airways
Nonneoplastic diseases of the trachea ( post intubation tracheal stenosis)
Benign and malignant tumors of the trachea ( squamous cell carcinoma, adenoid cystic
carcinoma, carcinoid tumor)Tracheal metastatic tumorCompression of trachea by vascular ring & other congenital anomalies( complete
tracheal rings)Tracheostomy
Mediastinum
Thymus gland ( tumors, myasthenia gravis)Mediastinal parathyroidsAcute and chronic mediastinal infections ( descending necrotizing mediastinitis)Primary mediastinal tumors and cystsMediastinal lymphadenopathies
Esopahgus
Trauma ( foreign bodies, esophageal burn, perforations)
Congenital anomaliesGastroesophageal refluxMotility disordersEsophageal diverticulaTumors ( benign and malignant tumors)
Diaphragm
Diaphragmatic hernias ( Buchdalek, Morgagni and paraesophageal)
Trauma and rupture of diaphragmTumors of diaphragmDiaphragmatic eventration and paralysis
( pacing of the diaphragm)
Pericardium
Pericardial effusions and cardiac temponade
Principles of thoracic surgery
Anatomic considerationNegative pressure of pleural space AnesthesiaLung functional capacities FEV1, VC, MVV Po2, Pco2, Dlco, Max O2 consumption
Physiologic considerationpulmonary physiologic assessment of operative risk
Pco2<45 mmHgDLco>60%Patient physical activity : climb 1-2 flights
of stairsPostoperative predicted FEV1Quantitative ventilation perfusion scanExercise testing : Max.O2 consumption>15 ml/kg/min predicted postop.Max O2 consumption>10
Diagnostic Procedures
Surgical pathology
Pleural biopsyTransbronchial biopsyLung (transthoracic) needle biopsyOpen lung biopsySegmentectomyLobectomyPneumonectomy
Cytology
Pleural fluidSputumBronchoalveolar lavageBronchial brushingLung fine-needle aspiration
Bronchoscopic Evaluation of the Lungs and
Tracheobronchial Tree
RIGID BRONCHOSCOPY
Foreign body removalMassive hemoptysisInfant endoscopyDilation of stricturesTracheal obstructionLaser bronchoscopy
Flexible Fiberoptic Bronchoscopy
Patient comfortSegmental visualizationSegmental biopsyPeripheral biopsyTransbronchial needle aspirationBedside aspirationBronchoscopy on ventilatorPhotographyIncreased cancer diagnosisBrachytherapyLaser bronchoscopy
Invasive Diagnostic Procedures
MEDIASTINOSCOPYScalene BiopsyTHORACENTESISNEEDLE BIOPSY OFTHE PLEURA
Video-Assisted Thoracic Surgery as
a Diagnostic Tool
Pleural EffusionMesotheliomaDiffuse Interstitial Lung DiseaseSolitary Lung NodulesLung Cancer StagingMediastinal DiseaseChest Trauma
Surgical approach to the chest
Incisions : Posterolateral thoracotomy incision Lateral thoracotomy incision Anterolateral thoracotomy incision Median sternotomy Clamshell incision Trapdoor incision Thoracoscopic approach
Technological progress
Video assisted thoracoscopic surgeryFiberoptic bronchoscopyVideo assisted mediastinoscopyImaging CT scan, MRI, Pet Scan, Dye studies,
isotope scan, ultrasonographyStaplers Medications , lung transplantation
Pain control : epidural analgesia, patient control analgesia, intercostal nerve block, TENS,….
Chest physiotherapy, bronchoscopy, tracheostomy
Anesthesia:Double lumen endotracheal tube, Intensive care
ONE LIMB IS PROGRESS IN THE SAME DIRECTION AS BEFORE
ANOTHER LIMB IS PROGRESS IN AN UNUSUAL DIRECTION
Future ?