Thoracic Surgery : Specialty that deals with the surgical treatment of pathology located in the rib cage with the exception of cardiac pathology , the field of action is delimited by the chest wall and the diaphragm .
The most frequently treated pathologies include oncological surgery of the lung , mediastinum, chest wall and pleura . It also deals with tracheal pathology, thoracic trauma, pleural diseases ( pneumothorax , empyemas , effusions).), the autonomic nervous system (hypersudation) and the thoracic duct. It participates together with other specialties in the multidisciplinary treatment of esophageal pathology and certain vertebral pathologies .
In recent years, one of the main interests of the specialty is the reconversion of classic surgical techniques into minimally invasive techniques that include thoracoscopic surgery of one or two ports, and resection of thoracic tumors by these routes.
[ hide ]
- 1 History of Thoracic Surgery
- 2 Periods of thoracic surgery
- 3 Evolution of thoracic surgery
- 4 Surgical scope
- 5 Specific training in thoracic surgery
- 6 Important Skills in Thoracic Surgery
- 7 Sources
History of Thoracic Surgery
There is no exact date or specific event that marks the beginning of Thoracic Surgery as such, and its roots are certainly multinational; however, the parallelism between the evolution of anesthesia -with all its extraordinary progress- and the progress and development of thoracic surgery, mainly thanks to the understanding of the physiological and pathophysiological processes of respiration , has been evident .
Historical facts such as tuberculosis epidemicsin different regions, they fostered the development of surgical techniques and knowledge regarding the respiratory process. Internationally, the most relevant milestones have occurred in Heidelberg -Germany- with Czerny when he carried out one of the first resections of an esophageal carcinoma in 1877 . Block in Danzig (present Gdansk) -Poland- in 1881 described one of the first experimental works of lung resection in rabbits. Forlanini in Pavia -Italy- introduced the concept of artificial pneumothorax for the treatment of tubercular caverns in 1882 . De Cérenville in Lausanne-Switzerland- described rib resection for lung collapse in 1885. Wheeler in Dublin described in 1886 a successful resection of an esophageal drive diverticulum. Rehn in 1897 in Frankfurt am Main – Germany – described the successful repair of a stab wound of the right ventricle in a young woman. In New York , Beck enacted pleurectomy as a treatment for empyema in 1897, and by 1911 Jacobeus introduced the concept of thoracoscopy . These are just a few of the countless examples of the origins of General Thoracic Surgery.
Periods of thoracic surgery
The first was determined around the year 1900 by General Surgeons those pioneers faced with pleuropulmonary suppuration and bronchiectasis during and after World War I and the outbreak of influenza in 1918 , devoid of antibiotics, transfusions and intensive care. They demarcated the roots of Thoracic Surgery.
The second period is marked by the explosive development of lung resection for tuberculosis followed by surgical treatment of lung cancer. It refined the surgical techniques of Specialized Thoracic Surgeons around World War II , establishing Thoracic Surgery as an autonomous specialty.
The third period focuses on the progression of some pulmonary surgeons towards cardiac surgery, culminating in the treatment of coronary artery disease and coronary bypass. This development eventually resulted in the divorce and birth of a new and completely independent specialty: Cardiovascular Surgery.
Evolution of thoracic surgery
In the last decades of the 20th century , with the changes in the epidemiological profile of developed and developing countries where neoplastic diseases have become more relevant due to an increase in their incidence; Thoracic surgery has taken a momentous turn towards high complexity with high technology .
Making an analogy of cardiovascular surgery, current thoracic surgery is inconceivable without the standardized use of anesthesia with monopulmonary ventilation with double lumen tube, epidural analgesia, invasive monitoring of hemodynamic and ventilatory status, intraoperative bronchoscopy, radical resections of thoracic tumors with bronchial reconstructions and parenchymal rescue. autologous pulmonary, pulmonary vascular reconstructions, chest wall plasties with prosthetic materials, interventions of the main airways with distal ventilatory by-pass. Interventional bronchoscopy for the treatment of endobronchial lesions. Radical esophageal cancer surgery with reconstruction of the digestive tract. All this, with the consequent need for essential support services such as oncology] and chemotherapy, intensive care,Pneumology , gastroenterology , radiology have made General Thoracic Surgery a very complex specialty that shares an interdisciplinary function, inserted in a very necessary way in modern medicine.
In such a way that in its evolution, General Thoracic Surgery continues to be a truly independent specialty from the already consolidated Cardiovascular Surgery, with separate programs in renowned universities around the world, with textbooks dedicated exclusively to independent medical associations (eg Society European Thoracic Surgery), specific sections for their research work in the different periodicals on thoracic sciences; and very importantly, it has been nominated in a clear and specific way: General Thoracic Surgery.
The thoracic surgeon is specialized in the pathological processes that affect the entire thoracic cavity, specifically the bronchi , ribs , diaphragm , esophagus, mediastinum, pleura, lungs and trachea . Except the heart and the great vessels, to which cardiovascular surgery is dedicated. It is usually associated with some non-surgical specialties, especially with the digestive system and pulmonology.
The type of pathological processes it treats are congenital, dysplastic, inflammatory, tumor or traumatic.
Specific training in thoracic surgery
The resident must be specifically trained in what will be his field of knowledge, for which he must rotate in the areas of: • External Consultations.
• Thoracic surgery operating room.
• Thoracoscopy unit.
• Bronchoscopy unit.
• Emergencies in thoracic surgery.
Important skills in thoracic surgery
- There is a strong intellectual and scientific component to thoracic surgery.
• Ease of dealing with the patient.
• In addition, good hand-eye coordination is necessary, although as always, these skills can be learned or improved by those who want to dedicate themselves to improving their technique.
• A thoracic surgeon must be smart enough and think logically to “make the right decisions before, during, and after surgery.”
• One respondent says that “the most important skill is the ability to promote calm to prevent a catastrophe.”
• Social skills that allow you to communicate serious events with the greatest tact and in the easiest way for the family.