when to call a thoracic surgeon
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when to call a thoracic surgeon for your chest disease patient. this lecture was conducted as part of post graduate teaching course for residents of chest disease department , Assiut university
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when to call a thoracic surgeon
- 1. When to call a thoracic surgeon Hussein Elkhayat,MD
- 2. Without a perfect preoperative assessment We are operating on the dark
- 3. Preoperative assessment – History – Imaging – Lab. – Interventional procedures – Pulmonary function – Treatment given – Counselling – metastatic workup
- 5. Assiut Cardiothoracic Surgery Dpt. – Founded as a unit in 1987 – Started closed heart surgery before being a unit in 1980 – Started open heart surgery in 1987 – Expanded to be a department in 1999 – Specialized unit for pediatric cardiothoracic surgery founded in 2009 with one OR and 9 PICU beds – Now dpt. includes 2 professors, 4 assistant professors , 7 lecturers, 9 assistant lecturers and 12 residents. – Department is sharing in Assiut trauma unit.
- 8. PECTUS
- 9. VATS
- 10. Assiut university HEART hospital 2016 – Soft opening in 26 Jan. 2016 – Total of 174 thoracic surgery cases (versus 211 cardiac cases) – 82 by one thoracic surgery dedicated team so far ( total of 45 last year ) – 43 VATS (52.4% ) – 39 UNIPORTAL (TOTAL OF 57case since 2012) (thoracic duct ligation , achalasia , wedges, extraction of penetrating FB, clotted hemothorax, decortication for stage 3 empyema, sympathectomy and LEFT UPPER LOBECTOMY ,LEFT LOWER LOBECTOMY ) – 4 VATS lobectomy (7 in total from 2015) ( one bilobectomy for bronchactasis via 2 port , one uniportal pneumonectomy with expert , one uniportal LUL for aspergilloma and left lower lobectomy for sequestrated lobe). – Two postoperative mortality in VATS cases (day 3 and 4 postop in IPF cases) – 3 VATS cases need reoperation (2 for bleeding and open for esophageal perforation )
- 11. Do we really need VATS ? The most dangerous phrase in the language is “ we’ve always done it this way “ Innovation There’s a way to do it better - Thomas Edison
- 12. Uniportal VATS
- 14. Video Assisted Thoracoscopic Surgery (VATS) Resection of Anterior Mediastinal Mass Cardiothoracic Surgery Department , faculty of Medicine , Assiut University
- 15. Removal of penetrating FB
- 16. Bullectomy
- 17. VATS LOBECTOMY • 69 yrs old male pt • Cancer larynx from 8 yrs • Operated for total laryngectomy with permanent tracheostomy • Receive postoperative adjuvant chemotheryapy and radiotherapy • Esophageal stricture with frequent endoscopic dilatation • Accidentally discovered left upper lung zone opacity • CT scan left upper lobe mass with no detectable LNs. • Oncolgist consultation suggest it is a second primary NOT a mets and recommend surgical treatment • PFT : !!!
- 18. Left VATS 2 ports access
- 19. VATS 2 ports LUL
- 20. Common conflicts Between surgeons and phycisians
- 21. Chest tube; insertion NEJM VIEDO !
- 24. Chest tube; common problems – Malposition – No drainage – Bleeding – Pain – Perforation – Massive air leak – Surgical emphysema
- 25. Chest tube; care – Dressing – Pain management – Chest x ray ? – Follow up – Removal – Chest tube for how long ? – CLAMPING
- 26. Empyema – Definition ,stages ,clinical presentation – Order of investigation ? – Treatment options
- 27. Empyema; ttt options – Chest tube – Rib resection – Early debridement – Streptokinase – Decortication – VATS decortication
- 29. Pneumothorax BTS 2010 Accepted indications for surgical advice should be as follows: – Second ipsilateral pneumothorax. – First contralateral pneumothorax. – Synchronous bilateral spontaneous pneumothorax. – Persistent air leak (despite 5-7 days of chest tube drainage) or failure of lung re- expansion. – Spontaneous haemothorax. – Professions at risk (eg, pilots, divers). – Pregnancy.
- 30. The future that we are looking for
- 31. Thank you