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Frequently Asked Questions (FAQs)

General Thoracic Surgery Questions

Q: What is thoracic surgery?

A: Thoracic surgery is the surgical treatment of diseased or injured organs in the chest (thorax), including the esophagus, trachea, pleura (the membranes that cover and protect the lung), mediastinum (the area separating the left and right lungs), chest wall, diaphragm, heart and lungs. Patients with diseases or conditions such as lung cancer, chest trauma, esophageal cancer, emphysema and lung transplantation may require thoracic surgery.

Q: What is a thoracic surgeon?

A: A thoracic surgeon is a medical doctor who performs operations on the heart, lungs, esophagus and other organs within the chest. Our practice has two dedicated board-certified general thoracic surgeons, which means they have completed five years of residency training in general surgery as well as undergone additional training in thoracic surgery and cancer research.

Our surgeons only practice general thoracic surgery; they do not perform any type of cardiac or vascular surgery. Instead, our thoracic surgeons specialize solely in diseases of the lung, esophagus and mediastinum, thus providing the best quality of care to patients with these diseases. It also makes for a stronger working relationship with colleagues in other specialties.

Q: When should I see a thoracic surgeon?

A: Your primary care physician or specialist may refer you to a thoracic surgeon if he/she feels you could benefit from a surgical procedure to treat a condition involving the heart, lungs, esophagus, mediastinum or chest wall. We also see self-referrals. If you think you should see a thoracic surgeon, call us at 954-265-1125 to schedule an appointment.

Questions About the Division

Q: What if I need to see another physician or if my treatment requires other modalities other than surgery?

A: Here at the Division of Thoracic Surgery we employ a multidisciplinary approach to patient care and collaborate very closely with colleagues in radiation therapy and medical oncology and also attend tumor discussions (tumor boards). As a result, each patient typically receives input from a variety of specialists to ensure they receive the best possible treatment.

Q: What type of patients do you see in your practice?

A: The Division of Thoracic Surgery provides specialty care to patients who have lung cancer, esophageal disease (e.g., achalasia, Zenker's diverticulum, hiatal hernia), mediastinal tumors (e.g., chest wall tumors, empyema, plural effusion), trachea and airway disorders and hyperhidrosis (excessive perspiration).

Questions About Surgical Techniques

Q: What is minimally invasive surgery?

A: Minimally invasive surgery uses advanced surgical techniques, high-definition imaging technology and precision instruments to work through tiny incisions to perform procedures, which results in quicker recovery times and less pain and discomfort than conventional surgical procedures.

Q: What are the benefits of minimally invasive surgery?

A: Compared to traditional surgery, minimally invasive surgery generally results in less blood loss, fewer complications, shorter hospital stays and a faster return to normal daily activities. Patients may also experience less post-operative pain and scarring with minimally invasive procedures.

Q: Do you perform robotic or minimally invasive surgery?

A: Yes, our thoracic surgeons are skilled and experienced in all forms of minimally invasive procedures including video-assisted thoracoscopic surgery (VATS), robotic surgery, endoscopic ultrasound and interventional pulmonology.

Q: What is VATS (video-assisted thoracoscopic surgery)?

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique where tiny, keyhole-sized incisions are made in the chest using small surgical instruments. A tiny camera (thoracoscope) is then inserted into the chest area via the small openings. Images from the camera are sent to TV monitors, which help guide the surgeon during surgery. In contrast to conventional open thoracotomy, VATS offers patients many benefits including fewer complications, less pain, faster recovery, a shorter hospital stay and less scarring. VATS is often used to diagnose and treat lung cancer, remove diseased lung sections or lobes, diagnose lung infections and treat collapsed lungs, among other diseases and conditions.

Q: What should I expect after surgery?

A: Following your surgery, you will be transferred to the recovery area where doctors and support staff will monitor you closely. When you have recovered sufficiently, you will be transferred to a hospital bed where you will be cared for until you are discharged. Fatigue is common after surgery but will improve over time. Keep in mind that you may feel fatigued for several weeks post surgery.

Although your appetite may not be where it was prior to surgery, a normal diet should be resumed as soon as possible. If you appetite has waned, consider adding a nutritional supplement, such as Ensure, to your diet in the interim.

Depending on the severity of your surgery, most patients will experience some post-surgery pain and discomfort. A pain reliever as well as anti-inflammatory medicine can help control the pain.

Lung Cancer Patients

Q: I have a lung nodule that needs to be removed through a procedure called pulmonary lobectomy. What is the operation like?

A: The lungs are comprised of lobes. The right lung has a superior lobe, middle lobe and inferior lobe. The left lung has a superior and inferior lobe. If a cancer or lesion is within a lobe of the lung, removal of the involved lobe is indicated.

Under general anesthesia with the patient deep asleep and pain free, an incision is made between the ribs to expose the lung. The chest cavity is examined and diseased lung tissue is removed. A drainage tube (chest tube) is inserted to drain air, fluid, and blood out of the chest cavity and the ribs and skin are closed.

Q: How long will I stay in the hospital?

A: The hospital stay for this procedure is usually 7 to 10 days. Deep breathing is important to help prevent pneumonia, infection and re-expansion of the lung. The chest tube remains in place until the lung has fully re-expanded. Pain is managed with medications.

Q: What will my recovery be like?

The patient recovers fully in 1 to 3 months after this procedure.

Patients with Esophageal Cancer

Q: I've been diagnosed with esophageal cancer. What are my treatment options?

A: If the esophageal cancer is only in the esophagus and has not spread, surgery is the treatment of choice. The goal of surgery is to remove the cancer.

An esophagectomy is surgery to remove part or all of the esophagus, the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

Minimally invasive esophagectomy is surgery to remove part or all of the esophagus, the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

Q: What is the operation like?

Minimally invasive esophagectomy is surgery to remove part or all of the esophagus, the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

There are many ways to do this surgery. Talk with your doctor about what type of surgery is best for you. It will depend on where in your esophagus your cancer is, how much it has spread, and how healthy you are.

Laparoscopy is one way to do this surgery:

  • Your surgeon will make three to four small cuts in your upper belly, chest, or lower neck. These cuts will be less than 1/2-inch long.
  • The laparoscope, with a camera on the end, will be inserted through one of the cuts into your upper belly. Video from the camera will appear on a monitor in the operating room. Other medical instruments will be inserted through the other cuts.
  • Your surgeon will close off one part of your stomach with staples and cut this section off. This part of your stomach will be used to form a new tube to replace the part of your esophagus that is removed.
  • Your surgeon will remove the part of your esophagus where your cancer is located, and any other related lymph nodes in the area.
  • Your surgeon will join together your rebuilt esophagus and stomach in your neck or chest. Where they are joined will depend on how much of your esophagus was removed.
  • Lymph nodes in your chest may also be removed if your cancer has spread to them. Your surgeon will remove them through a cut in the lower part of your neck.
  • Your surgeon will place a feeding tube in your small intestine so that you can be fed while you are recovering from the surgery.

Q: Why is this procedure performed?

A: The most common reason for removing part, or all, of your esophagus is to treat cancer. You may also have radiation therapy or chemotherapy before or after surgery. Surgery to remove the lower part of your esophagus may also be done to treat:

  • Achalasia, a condition in which the esophagus doesn't work well
  • Pre-cancerous changes in the tissue of your esophagus, called high-grade dysplasia (Barrett's esophagus)
  • Severe trauma

Q: Are there any risks associated with this procedure?

A: Esophagectomy is major surgery and has many possible risks. Some of them are serious. You should discuss these risks with your surgeon. The risks from this surgery, or for problems after surgery, may be greater than normal if:

  • You are unable to walk even for short distances, which increases the risk of blood clots, lung problems, and pressure sores
  • You are still growing
  • You are older than 60 to 65
  • You are a heavy smoker
  • You are obese
  • You have lost a lot of weight from your cancer
  • You are on steroid medications

There are risks associated with anesthesia, which include:

Risks for any surgery are:

Risks for this surgery include:

  • Acid reflux
  • Injury to the stomach, intestines, lungs, or other organs during surgery
  • Leakage of the contents of your esophagus or stomach where the surgeon joined them together
  • Narrowing of the connection between your stomach and esophagus

Patients with Benign Esophageal Diseases

Q: I have benign esophageal disease. What are my treatment options?

A: The goals of benign esophageal disease treatment are to relieve symptoms and prevent complications. Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) will relieve pain. Medications that neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed.

There are other measures to reduce symptoms including: avoiding large or heavy meals, not lying down or bending over right after a meal, reducing weight and not smoking.

If these measures do not control the symptoms, or you have complications, you may need surgery to repair the hernia (see hiatal hernia Q&A below).

Q: I have been scheduled for a hiatal hernia repair. What does the operation entail?

When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux: GER) as gastric acid backflows from the stomach into the esophagus. Hiatal hernia repair is surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).

Hiatal hernia repair may be recommended when the patient has:

  • severe heartburn
  • severe inflammation of the esophagus from the backflow of gastric fluid (reflux)
  • narrowing of the opening (hiatus) through the diaphragm (esophageal stricture)
  • chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids

While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the abdomen.

The stomach and lower esophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux.

Q: How long will I stay in the hospital?

Patients may need to spend three to 10 days in the hospital after surgery. A tube will be placed into the stomach through the nose and throat (nasogastric tube) during surgery and may remain for a few days. Small, frequent feedings are recommended.

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