Thoracic Surgery

Traditionally these surgeries were done by making big incisions over the chest, cutting all the muscles of the chest wall and applying a retractor to spread the ribs or cutting the breast bone to get into the chest and do these operations. This causes immense trauma to the patient leading to delayed recovery from surgery, excessive pain and high rates of post-operative complications. We do most of these procedures by minimally invasive techniques which are VATS and robotic thoracic surgery.

VATS is minimally invasive thoracic surgery performed by introducing a small camera and instruments through tiny cuts over the chest wall. VATS provides excellent visualization of the thorax, allowing the surgery to be performed even in sick and elderly patients who have marginal pulmonary reserve. Almost all operations in the chest can be done by this technique which avoids excessive pain and complications of open surgery. It also offers better cosmesis and the patient can return to work very soon after the surgery.

Robotic Thoracic Surgery is an integral part of Max Hospital. Here, we offer the latest cutting edge technology (da Vinci Xi robotic system) to provide the best outcome to our patients. The surgeon at the robotic console controls the robot to do the precise surgery of the patients along with all the benefits of minimally invasive surgery. Robotic technology provides highly magnified 3-D visualization and excellent dexterity by 7 degrees of freedom of robotic instruments which allow difficult dissections in narrow fields with better surgical ergonomics. This allows the surgeon to perform technically demanding complex operations with great precision and ease. .

We provide a complete range of services, from initial evaluation and management for rare and complex diseases and new surgical approaches, device, and technologies. We collaborate with experts in many specialties providing multi-disciplinary approach for treatment of these complex disorders

We follow enhanced recovery protocols after thoracic surgery where the goal is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs.

Bronchiectasis is a disease in which there is permanent and irreversible enlargement of the airways of the lung. Causes can be both acquired and congenital (since birth). Common symptoms are cough with excessive sputum, blood in cough, foul smelling breath, frequent chest infections and breathlessness. Surgical removal of the diseased lung is advised in patients not responding to medical treatment. At Max we do these surgeries by key hole techniques also.

An aspergilloma, is also known as a mycetoma or fungus ball, occurs in patients with pre-existing cavitatory lung diseases such as tuberculosis. It may be asymptomatic or , cause cough with , blood in sputum or even life threatening bleeding. Medical treatment is usually not effective. Surgical removal of diseased lung in symptomatic patients (even asymptomatic) provides permanent cure. At Max we do these surgeries by all the three techniques depending upon indications and feasibility.

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. It can also occur in lungs along with other parts of the body. Common symptoms are chest pain, cough, breathlessness and blood in cough. Treatment of choice is surgical removal of the diseased part..

Bullae on the membrane that covers the lung, smaller in size are also called blebs. Lung bulla is a thin air sack filled with air and are very fragile, likely to burst. When they the entire lung collapses as a result of pneumothorax. Patients may experience difficulty in breathing, chronic coughing, chest pain, and other symptoms (lack of oxygen in the blood). Surgery is usually needed in patients with: large bullae causing breathlessness, increasing size of bulla, recurrent pneumothorax, infected bullae not responding to medical treatment, acute respiratory failure, and acute distension of the bulla. We offer key-hole surgery to these patients with excellent outcomes.

Emphysema is a disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). Lung volume reduction surgery (LVRS) is a surgical procedure to remove diseased, emphysematous lung tissue. This procedure reduces the size of an over-inflated lung and allows the expansion (growth) of the remaining, often more functional lung. LVRS improves exercise capacity, lung function and quality of life. We offer key-hole surgery to these patients with excellent outcomes

Lung nodule usually shows up on a chest X-ray or a CT scan that has been carried out on a person who has symptoms of a respiratory illness. Nodules can occur in lungs due to various causes ranging from infections to cancer. We at Max Hospital have specialized team of doctors who evaluate and treat patients having lung nodules. Surgery if required is done by key hole method.

Lung cancer (LC) is the leading cause of cancer-related deaths in India and globally. People who smoke have the greatest risk of lung cancer, though lung cancer can also occur in people who have never smoked. The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pain. At Max we have a dedicated team for lung cancer treatment including a thoracic surgeon, pulmonologist, medical oncologist, radiation oncologist, pathologist, physical therapist, dietitian who together provide comprehensive personalized care to the patient. We also have state of art infrastructure and equipment required for disease evaluation and treatment. Our surgeons offer lung-conserving surgery to remove the cancer completely and yet preserve remaining lung tissue whenever possible. We prefer minimally invasive techniques to do these surgeries.

The pleural cavity is the space that lies between the pleura, the two thin membranes that line and surround the lungs.

Empyema is a collection of pus in between the lung and the inner surface of the chest wall (pleural space). Common causes for empyema are tuberculosis, pneumonia, penetrating chest injury, esophageal rupture, complication from lung surgery, or inoculation of the pleural cavity after needle aspiration or chest tube placement. Sometimes a peel forms over the lung surface and inner lining of chest which restricts the expansion of lung along with poor penetration of antibiotics. VATS decortication removes all the pus from the chest cavity along with the complete peel allowing the lung to expand.

Hemothorax is a condition wherein blood collects between the chest wall and the lungs. Most common cause of hemothorax is chest injury. Hemothorax is commonly treated by inserting a tube in chest cavity. Sometimes the blood is clotted or loculated or may get infected to form an empyema. These patients often need surgical drainage. We do treat these patients by key hole surgery. Broken ribs (usually seen in patients with trauma) are also fixed during the surgery.

Thoracoscopy is recommended to establish a diagnosis in patients with undiagnosed pleural effusions. It allows direct visual assessment of the pleura and subsequent biopsy of visually abnormal areas, hence maximising diagnostic yield. Thoracoscopy may be performed either under general anaesthesia or under sedation with local anaesthetic. Pleurodesis can be undertaken during thoracoscopy if the pleura appears abnormal on direct inspection to prevent recurrence of pleural effusion.

Results from leakage of lymphatic fluid from the thoracic duct. Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.

Mediastinum is an area found in the midline of the chest that is surrounded by the breastbone in front, the spine in back, and the lungs on each side. It contains the heart, thymus gland, portions of the esophagus and trachea, and other neuro-lymphoid structures.

Myasthenia gravis is an autoimmune disorder, characterized by weakness and rapid fatigue of any of the muscles under voluntary control. Around 10-15 percent of people with myasthenia gravis have a thymoma. Another 60%, however, will have other abnormalities of the gland including thymic hyperplasia (an enlarged gland).Thymectomy has been a mainstay in the surgical treatment of myasthenia gravis and helps over 85% of myasthenia gravis patients. We do extended thymectomy by minimally invasive /robotic techniques.

Thymoma is a tumor of thymus gland. Patients with thymoma may also have other autoimmune disease (like myasthenia, pure red cell aplasia). Most of the patients don’t have any symptoms and the tumor is detected incidentally. Complete surgical removal helps long term cure to these patients. We offer key-hole & robotic surgery to these patients with excellent outcomes.

Mediastinal masses are caused by a variety of cysts and tumors. Likely causes differ by patient age and by location of the mass (anterior, middle, or posterior mediastinum). Mediastinal tumors (both benign and malignant) that are left untreated can cause serious complications including invading the heart, pericardium (the lining around the heart), and great vessels (the aorta and vena cava). Tumors located in the posterior (back) mediastinum can cause compression of the spinal cord. Almost 40% of people who have mediastinal tumors experience no symptoms. Most of the growths are often discovered incidentally on a chest x-ray which is performed for some another reason. When symptoms are present they are often a result of the compression of surrounding structures, such as the spinal cord, heart or the pericardium (the heart’s lining). Treatment depends on the cause. Most malignant tumors should be removed surgically, but some, such as lymphomas, are best treated with chemotherapy.

The esophagus or foodpipe is a muscular tube that moves food and liquid from the throat to the stomach.

These are non-cancerous tumors on the wall of the esophagus and not life-threatening. These often go undetected until they grow large enough to make swallowing difficult. We do surgical excision of these tumors by VATS / robotic surgery.

Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. At Max we have a dedicated team of experts including a thoracic surgeon, gastroenterologist, medical oncologist, radiation oncologist, pathologist, physical therapist, dietitian who together provide comprehensive personalized care to the patient. We also have state of art infrastructure and equipment required for disease evaluation and treatment. We use minimally invasive techniques including VATS & Robotic techniques to perform these surgeries.

May cause symptoms like difficulty in swallowing and problems with breathing. We do surgical excision of these tumors by VATS/ robotic surgery

Esophageal diverticula are small pouches that form in the esophagus. Most patients are unaware of these pouches until they fill with food and become inflamed or infected, also known as diverticulitis. Symptoms are difficulty swallowing, heartburn, regurgitation of food, hoarseness, repeated pneumonia, repeated episodes of inhaling food into airway or lungs, bad breath. We offer key-hole surgery to these patients with excellent outcomes

Tumors can block the airway and cause breathing problems. Most of the tumors that form in the trachea and bronchi in adults are cancerous, but a few are noncancerous. Multidisciplinary experts at Max hospital are experienced in selecting the appropriate treatments for patients with tracheal and bronchial tumors. Treatment may include surgical excision, bronchoscopic treatments or radiation therapy, either alone or in combination. In patients who are not candidates for complete surgical removal of the tumor, these therapies may be used to help restore breathing and slow down the tumor progression.

Other airway diseases treated surgically ````are tracheal stenosis, tracheobronchomalacia and tracheoesophageal fistula

The pericardium is a thin sac that surrounds the heart. It protects the heart and provides the lubrication for the heart.

Constrictive pericarditis is long-term inflammation of the pericardium. Inflammation in this part of the heart causes scarring, thickening, and muscle tightening, or contracture. If it left untreated, a rigid pericardium can lead to symptoms of heart failure, which may even be life-threatening. Most common cause is tuberculosis. There are effective treatments for the condition. The definitive treatment for constrictive pericarditis is perirecardiectomy which is a surgical procedure where the entire pericardium is peeled away from the heart. This allows the heart to move freely.

A pericardial window is done to drain the excessive fluid around the heart. It can also help diagnose the source of the extra fluid. Conditions that might need a pericardial window include metastatic cancer, iImmune system disease and metabolic causes, like kidney failure with uremia. We offer key-hole surgery to these patients with excellent outcomes

Diaphragm, dome-shaped, muscular and membranous structure that separates the thoracic (chest) and abdominal cavities. It is the primary muscle used in respiration, as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.

The term ‘diaphragmatic eventration’ is used in common practice to describe a condition of relaxation of the diaphragmatic dome. It may present at birth as a congenital condition due to a defect of diaphragmatic development or in a later stage of life as an acquired condition (‘acquired diaphragmatic paralysis’ or ‘acquired diaphragmatic elevation’).

The patients may experience respiratory symptoms such as breathlessness, cough or chest pain particularly on exertion. The goal of surgical correction is to place the diaphragmatic leaflet in a position of maximum inspiration which relieves compression on the lung parenchyma and allows its re-expansion

We offer key-hole surgery/robotic plication to these patients with excellent outcomes

Holes in diaphragm leading to abdominal structures coming into thoracic cavities. This can be due to some injury /trauma, or post-surgery or even from birth. These have to be repaired irrespective of whether symptomatic or not. We offer minimally invasive/VATS/robotic techniques for the problem.

The chest wall is also known as thoracic wall, it is the boundary of the thoracic cavity

Chest wall tumors may be malignant (cancerous) or benign (non-cancerous), and may originate there or have spread from elsewhere.

Treatment can vary based on factors such as the type of tumor and the stage of its progression. Surgical resection is the mainstay of treatment for most early stage chest wall tumors. Additional treatment can include radiotherapy and/or chemotherapy.At Max hospital the thoracic surgeon will coordinate a team of specialists in the management of this disease.

Chest wall deformities are structural abnormalities in the chest. These structural abnormalities can be classified into two different types:

• Pectus excavatum: known as “sunken” or “funnel” chest,
• Pectus carinatum: known as “pigeon” chest

At Max hospital our surgeons use minimally invasive techniques (NUSS technique) to correct theses deformities

Chest wall infection may occur in soft tissue, cartilage and bone. Treatment depends on type location and magnitude of infection. Treatment may range from use of antibiotics to surgical resection of devitalized tissue and subsequent coverage with well vascularized soft tissue. At Max hospital the thoracic surgeon will coordinate a team of specialists in the management of this disease.

Hyperhidrosis is a condition characterized by abnormally increased sweating in excess of that required for regulation of body temperature. Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment. It is a medical condition wherein the patients aren’t able to join armed forces, also makes their professional life (in few selected fields) virtually impossible.

Endoscopic thoracic sympathectomy is used mainly as a treatment for excessive sweating of palms (Palmar Hyperhidrosis) but can also be used to help treat in few extreme cases of facial flushing.

Endoscopic thoracic sympathectomy is a key hole surgery of the chest which is offered to patients who have hyperhidrosis of underarms and hands or facial blushing. Surgery is the only permanent cure for this entity. Surgery is usually considered after failure of other modes of treatment.