Thoracic surgery
Thoracic surgery is a specialized field of medicine focused on surgical interventions within the chest cavity, which houses vital organs such as the heart, lungs, trachea, and major blood vessels. This surgical discipline primarily addresses conditions related to these organs, especially heart diseases and disorders of the major blood vessels. Thoracic surgeons undergo extensive training, typically involving six years of general surgery and three years of thoracic surgery, leading to certification from recognized medical boards.
The procedures performed by thoracic surgeons include heart valve replacements, aneurysm repairs, and heart transplants, among others. Techniques such as thoracotomy allow access to the chest cavity for these surgeries, often requiring sophisticated support systems like heart-lung machines to maintain blood circulation during operations. Diagnostic tools employed in thoracic surgery are advanced, including echocardiography, CT scanning, and cardiac catheterization, which help in accurate assessments before surgical intervention.
Historically, thoracic surgery gained prominence in the early twentieth century and has evolved significantly, particularly due to advances in technology and techniques. Today, the field continues to progress, with innovations such as robotic-assisted surgeries and improvements in artificial hearts showcasing the ongoing development in thoracic surgical practices.
Thoracic surgery
Anatomy or system affected: Chest, heart, lungs, respiratory system
Definition: The branch of surgery that treats diseases of the chest cavity, especially the heart
Science and Profession
The chest, or thorax, lies between the neck and the abdomen, from which it is separated by the diaphragm. Its side boundaries are the ribs and the muscle that surrounds them, which are attached to the spine and breastbone (sternum) in the back and front of the body, respectively. Overall, the thorax is cone-shaped, with its small and large ends bounded by the neck and diaphragm. Inside this airtight cavity, the lungs are suspended on the right and left sides, covered by the membranous pleura. Between the lungs is the heart, with its covering, the pericardium.
Also located in the chest cavity are the trachea (windpipe), which leads to the lungs; the esophagus, which connects the mouth and stomach; the major blood vessels that enter and leave the heart; and nerves. The chest cavity inflates and deflates as a result of diaphragm and rib muscle movement. This action provides the entry of oxygen to the blood that is circulated around the body through the cardiovascular system.
Thoracic surgeons, sometimes called cardiothoracic/cardiovascular and thoracic surgeons, handle a wide variety of surgery associated with these organs. Preeminent in many cases is surgery of the heart and major blood vessels. This precise, exacting surgery requires residency training of six years in general surgery and three years in thoracic surgery. In the United States, thoracic surgeons are certified by the American Board of Surgery and the American Board of Thoracic Surgery. Much of the time of thoracic surgeons is spent in hospitals working with critically ill patients whose lives depend on the prompt use of technical and demanding surgical techniques. Most patients are aged fifty-five to sixty-five.
Diagnostic and Treatment Techniques
The diagnostic techniques associated with thoracic surgery are highly refined. They include careful patient histories, laboratory tests, and noninvasive techniques such as echocardiography, computed tomography (CT) scanning, electrocardiography (ECG or EKG), and other types of electrophysiology. Invasive procedures include cardiac catheterization and cineangiography of the heart and surrounding blood vessels with fiber-optic devices. Hence, cardiothoracic surgeons require extensive technical backup and wide expertise. After a quick, careful assessment of all information obtained, surgery is carried out. Thoracic surgeons are noted for great surgical dexterity, scientific expertise, and logical, stepwise development of a complete picture that enables them to arrive rapidly at sensible decisions before and during surgery.
Entering the chest cavity, thoracotomy is required for all thoracic surgery. Patients are given a general anesthetic and concurrently have heart and lung function replaced by a heart-lung machine, which oxygenates the blood and pumps it through the cardiovascular system.
Anterior thoracotomy is used to gain access to the heart and its coronary arteries. First, a vertical incision is made from between the collarbone to the lower end of the sternum, to which the ribs are attached. The sternum is divided with a bone saw and pried apart to expose the surgical area. After surgery, a drain is inserted into the chest, the sternum is wired together, and the muscle and skin are closed.
Lateral thoracotomy uses curved incisions made from between the shoulder blades and around the side of the trunk to just below a nipple. It provides access to the lungs and the great blood vessels. This technique is used by thoracic surgeons, general surgeons, and other specialists who perform lung surgery. After the incision is complete, the ribs are spread apart, and surgery is performed. Closure is as with the anterior procedure.
Many different thoracic surgery procedures are carried out on heart and great blood vessels when medical and dietary treatments fail or in cases of congenital and traumatic problems. They can be divided into valve replacement, artery surgery, and heart transplantation. Once, bypass surgery was a major aspect of cardiothoracic surgery. In the early twenty-first century, it was largely replaced by balloon catheterization and related techniques carried out by other specialists.
Three types of important cardiothoracic surgery are heart valve replacement, aneurysm resection, and heart transplantation. Heart valve replacement may be necessitated by severe mitral valve damage, which causes mitral insufficiency or stenosis that can lead to heart failure and death. Aneurysms are weakened portions of the heart or great blood vessels. Heart aneurysms are caused by myocardial infarction (the death of parts of the heart muscle), yielding areas of weak, noncontractile scar tissue. Vessel aneurysms are caused by atherosclerosis or infectious disease. In extreme cases, aneurysms can rupture, and they are always painful and/or life-threatening. They are repaired by resection and replacement with graft materials such as Dacron or Teflon appliances. In the most severe cardiac problems, whole heart transplantation is needed using cadaver hearts. When this is not possible but the heart must be aided, ventricular assist pumps and artificial hearts can be connected temporarily.
Perspective and Prospects
Thoracic surgery was first successful in the United States in the early twentieth century. Development of the New York Thoracic Surgical Society in 1917 began its acceptance as a medical specialty. In the 1930s, the Journal of Thoracic Surgery started to describe the area, and treatment methods evolved rapidly. Much impetus came from thoracic injuries that occurred during World War II. By the late 1940s, a Board of Thoracic Surgery was affiliated with the American Board of Surgery. In 1971, it became the independent American Board of Thoracic Surgery, which certifies thoracic surgeons. There are several thousand board-certified thoracic surgeons.
Some firsts in this field were the relief of mitral stenosis, by Elliott Cutler (1923); surgical intervention for cardiac aneurysm, by Ernst Sauerbruch (1931); the successful ligation of an arterial duct, by Robert Gross (1939); the development of a heart-lung machine for humans, by John Gibbon (1954); and the relief of congenital pulmonary defects, by Alfred Blalock (1954).
In modern thoracic surgery, the treatment of coronary artery disease, once restricted to surgical bypass, has largely been replaced by techniques performed by cardiologists. Nevertheless, thoracic surgical procedures continue to improve, and the development of ever-better diagnostic tools and appliances is expected, such as a satisfactory artificial heart. Such improvements include robot-assisted and uniportal video-assisted thoracic surgery.
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