Healthcare services are delivered by experienced healthcare professionals who use modern equipment with advanced technology.
Lung Cancers
First, the lung cancer is diagnosed and staged, and next, the lung cancer is treated with closed (VATS – Video-assisted thoracoscopic surgery) or conventional open surgery techniques.
Since lung cancer becomes symptomatic rarely before it spreads to close organs and tissue, early diagnosis can be made in approximately 15% of the patients. Check-up once a year for all healthy people boosts the chance of early diagnosis substantially in all cancers, especially the lung cancer, and other diseases. Particularly, smokers should have at least chest X-ray at least once or twice a year after they are 40. Surgery is the primary treatment for the lung cancer that is detected in an early stage.
Chemotherapy or radiotherapy may not be required depending on the result of “pathological staging” performed after the surgical treatment. However, postoperative chemotherapy, radiotherapy and/or immunotherapy are a must for “advanced” stages of the disease.
Video Assisted Thoracoscopic Surgery (VATS)
One or three incisions, each measuring several centimeters in length, are made on the chest wall; the video camera and surgical instruments are inserted into the chest cavity and a “close” surgery is performed under general anesthesia to eliminate the existing pathology.
This technique can be performed by experienced surgeons for following conditions;
- Lung cancer surgeries,
- Mediastinal tumors,
- Thymus cancers,
- Treatment of hyperhydrosis
- Lung biopsies,
- Nodular lesions of lungs,
- Treatment of pneumothorax,
- Cystic and bullous diseases of lungs,
- Metastatic lung tumors/cancers,
- Selected (early stage) lung cancers with limited cardiac reserve,
- If previous lung diseases (or surgeries) had not caused serious adhesions.
Chest Wall Cancers
First, histopathological diagnosis should be made for mass lesions that may develop in the chest wall and next, the council makes a decision on selection and use of advanced treatment modalities (surgery, chemotherapy, radiotherapy, immunotherapy etc.).
The patients should be preoperatively prepared in detail for the surgery. Considering the surgical treatment, the mass lesion in chest wall (if malignant) and at least 4-cm healthy tissue should be principally removed; the remaining cavity should be closed well with appropriate surgical materials and techniques.
Surgical Treatment of Esophageal Diseases (Benign & Malignant)
Thoracic surgeons use esophagoscope to detect the esophageal diseases. This optic device is used to investigate the problems arising out of the diseases that occur or involve this organ; caliber and length of the esophagus are determined and biopsy specimens are taken for suspected diseases.
If a mass lesion is detected, the diagnosis should necessarily be made in coordination with Gastroenterologist and it may be required to cooperate with General Surgery department, if a surgical procedure is needed.
Repair of Chest Wall Deformities (Nuss & Abramson & Ravitch & Robicsek Techniques)
- Pectus Excavatum (80%)
- Pectus Carinatum (15%)
- Pectus Arcuatum (<1%)
- Poland Syndrome
- Pentalogy of Cantrell
One or 2 metal bars are placed behind the sternum with VATS to correct Pectus Excavatum and Nuss technique is used for treatment of congenital or acquired chest wall deformities. The Nuss technique is an effective treatment method for the sunken breastbone and the deformity can be corrected within 30 to 45 minutes with small incisions.
Abramson technique is used for Pectus Carinatum; the correction is done by placing 1 or 2 bars over the breastbone or with subcutaneous approach.
Open surgeries are usually performed for correction of other diseases.
Pectus excavatum and carinatum are still managed with “Open correction techniques” (Ravitch and Robicsek techniques) depending on preferences of patients and surgeons. Success and complication rates are very similar for open and close techniques. Closed surgery techniques take shorter time relative to open techniques.
Hyperhydrosis – ETS (Endoscopic Thoracic Sympathectomy)
Sweating is a physiological event and it is severe enough to cause discomfort in 1% of healthy people. Sweating is regulated by sympathetic nerves over the autonomous nervous system (in order to adjust the body temperature relative to the ambient temperature). Excitement and stress are most important causes of abnormal sweating (excluding internal diseases); smoking and alcohol consumption also increase the sweating. Hyperhydrosis can be generalized or regional. The cause of generalized hyperhidrosis is usually hot weather, stress and systemic diseases; abnormal sweating mostly occurs in hands, faces, armpits and feet in regional hyperhidrosis. The underlying cause is increased sympathetic activity. Regional sweating threatens the social life and the psychology of the person; the most common complaints of those people are inability to contact eyes, social isolation, inability to play a music instrument, inability to write, inability to document and associating bad odor in hyperhidrosis of armpits/feet. Today, 4 methods are used for treatment of hyperhidrosis;
- Medical treatment (cream, lotion etc.)
- Iontophoresis (electric current, 15 mV)
- Botox,
- ETS (Endoscopic Thoracic Sympathectomy)
Iontophoresis (abnormal sweating in hands and feet; the procedure should be repeated for several times in a week in some cases) and Botox are easily performed in palmar/axillary hyperhidrosis and they should be repeated at 4- to 6-month intervals, as their effects are transient. For ETS, one or two linear incisions, measuring 1.5 cm in length, are made in the armpit and extended to the chest wall and next, the sympathetic nervous system is blocked by visualizing the surgical site with a video camera.
The sympathetic chain is divided, cauterized or blocked with a clip at level of Th2 or a lower level depending on the involved body part; this approach ensures permanent effect. The surgery lasts for half an hour; since it is an endoscopic procedure or in other words, a video camera is used, postoperative chest drain is not required and patients are discharged within 24 hours after the surgery. The procedure is performed at both sides of the body in most of the cases. This surgery leads to dryness and warmth in hands, but no motor or sensorial deficit is expected under normal circumstances.
There is only one reason that hinders an endoscopic technique for this surgery; it is the adhesion of lungs to the chest wall (secondary to previous surgeries or lung infections associated with pleurisy etc.) and in this case, the procedure is carried out with an incision made in the armpit. Both endoscopic and open sympathectomy surgeries do not cause a cosmetic problem, as the incision scar is hidden in the armpit. Mild to moderate reflex sweating is postoperatively observed in 60-80% of the cases. However, medical treatment and/or nerve restoration surgery may be required for Reflex sweating in 5-10% of the group. Iontophoresis and Botox can be considered for plantar hyperhidrosis, but the condition regresses in 50% of patients following ETS.
Thoracic Traumas
It implies loss of anatomic and functional integrity in structures that form the chest wall with a direct or indirect effect. It accounts for 25-30% of trauma-related deaths. Patients are usually men and aged 25 to 50 years. The common underlying causes are fall from height, traffic accidents, ballistic trauma, sharp object injury and entrapment (pressure on chest wall). The most common type of trauma is the blunt thoracic trauma; it is secondary to fall, entrapment and traffic accident. Complaints of the patient are flank pain at involved side, shortness of breath and subcutaneous emphysema as well as severe local pain (in case of rib fracture). Rib fracture occurs in 35-40+ of blunt traumas; it is located at level of 4th to 9th ribs. If the 1st rib is fractured, it is associated with serious injury. Sternum fracture is detected in 4% of the trauma patients, while flail chest is noted in 5-15% of the cases.
Thoracotomy is required in 5-15% of the patients with thoracic trauma; degree of the injury is dictated by trace of the bullet, length of barrel and shot distance in ballistic traumas. It is necessary to keep in mind that injury of more than one body system is likely in victims of traffic accident and that laparotomy should be prioritized, if hemodynamic parameters impair in thoracic and abdominal injuries. Internal organ injury should be carefully evaluated in sharp object injuries.
Thoracic Outlet Syndrome (TOS)
This disease is more prevalent in women and it is characterized by pain and numbness in bilateral upper limbs or poor exercise capacity; the main pathology is entrapment of blood vessels (arteries and veins) and nerves that are located in the upper outlet of the chest wall and extend to arms. These patients are usually unhappy people, as they present to neurologists, orthopedists and physiatrists in a repeated manner, but they cannot reach a solution. The complaints are neurovascular symptoms caused by entrapment of blood vessels and nerves between the clavicle, 1st rib and scalene muscles (most commonly the cervical rib); the condition is manifested by quick tiredness, pain, numbness, tingling and even feeling of cold in arms while hanging up the laundry, writing and carrying heavy bags/objects.
The most important diagnostic tools are a comprehensive physical examination and anamnesis, but radiology studies and ulnar nerve conduction rate ((EMG) help physicians guide the treatment. Although the treatment is medical in nature that primarily focuses on the symptoms, surgical treatment should be considered in patients who do not respond to the medication treatment. Surgical treatment involves scalene myotomy and resection of the cervical rib/1st rib, after the underlying cause is definitely detected.
