BAGHAI THORACIC SURGEON FIROOZGAR HOSPITAL THORACIC SURGERY

F ield of General Thoracic Surgery Chest wall Pleural space Lung Airways Mediastinum Esophagus Diaphragm Pericardium

Chest wall Chest wall deformities Chest wall tumors Thoracic outlet syndrome Infections of the chest wall Hyperhydrosis( thoracic sympathectomy) Anterior transthoracic approaches to the spine Chest wall radiation necrosis( chest wall reconstruction)

Pleural space Empyema Pneumothorax Pleural effusion Chylothorax Malignant mesothelioma

Lung Congenital lesions of the lung Bacterial infections Pulmonary tuberculosis Hydatid disease of the lung Lung cancer and other tumors Solitary pulmonary nodule Lung transplantation

Airways Nonneoplastic diseases of the trachea ( post intubation tracheal stenosis) Benign and malignant tumors of the trachea ( squamous cell carcinoma, adenoid cystic carcinoma, carcinoid tumor) Tracheal metastatic tumor Compression of trachea by vascular ring & other congenital anomalies( complete tracheal rings) Tracheostomy

Mediastinum Thymus gland ( tumors, myasthenia gravis) Mediastinal parathyroids Acute and chronic mediastinal infections ( descending necrotizing mediastinitis) Primary mediastinal tumors and cysts Mediastinal lymphadenopathies

Esopahgus Trauma ( foreign bodies, esophageal burn, perforations) Congenital anomalies Gastroesophageal reflux Motility disorders Esophageal diverticula Tumors ( benign and malignant tumors)

Diaphragm Diaphragmatic hernias ( Buchdalek, Morgagni and paraesophageal) Trauma and rupture of diaphragm Tumors of diaphragm Diaphragmatic eventration and paralysis ( pacing of the diaphragm)

Pericardium Pericardial effusions and cardiac temponade

Principles of thoracic surgery Anatomic consideration Negative pressure of pleural space Anesthesia Lung functional capacities FEV1, VC, MVV Po2, Pco2, Dlco, Max O2 consumption

Physiologic consideration pulmonary physiologic assessment of operative risk Pco2<45 mmHg DLco>60% Patient physical activity : climb 1-2 flights of stairs Postoperative predicted FEV1 Quantitative ventilation perfusion scan Exercise testing : Max.O2 consumption>15 ml/kg/min predicted postop.Max O2 consumption>10

Diagnostic Procedures

Surgical pathology Pleural biopsy Transbronchial biopsy Lung (transthoracic) needle biopsy Open lung biopsy Segmentectomy Lobectomy Pneumonectomy

Cytology Pleural fluid Sputum Bronchoalveolar lavage Bronchial brushing Lung fine-needle aspiration

Bronchoscopic Evaluation of the Lungs and Tracheobronchial Tree

RIGID BRONCHOSCOPY Foreign body removal Massive hemoptysis Infant endoscopy Dilation of strictures Tracheal obstruction Laser bronchoscopy

Flexible Fiberoptic Bronchoscopy Patient comfort Segmental visualization Segmental biopsy Peripheral biopsy Transbronchial needle aspiration Bedside aspiration Bronchoscopy on ventilator Photography Increased cancer diagnosis Brachytherapy Laser bronchoscopy

Invasive Diagnostic Procedures MEDIASTINOSCOPY Scalene Biopsy THORACENTESIS NEEDLE BIOPSY OFTHE PLEURA

Video-Assisted Thoracic Surgery as a Diagnostic Tool

Pleural Effusion Mesothelioma Diffuse Interstitial Lung Disease Solitary Lung Nodules Lung Cancer Staging Mediastinal Disease Chest Trauma

Surgical approach to the chest Incisions : Posterolateral thoracotomy incision Lateral thoracotomy incision Anterolateral thoracotomy incision Median sternotomy Clamshell incision Trapdoor incision Thoracoscopic approach

Technological progress Video assisted thoracoscopic surgery Fiberoptic bronchoscopy Video assisted mediastinoscopy Imaging CT scan, MRI, Pet Scan, Dye studies, isotope scan, ultrasonography Staplers Medications, lung transplantation

Pain control : epidural analgesia, patient control analgesia, intercostal nerve block, TENS,…. Chest physiotherapy, bronchoscopy, tracheostomy Anesthesia:Double lumen endotracheal tube, Intensive care

ONE LIMB IS PROGRESS IN THE SAME DIRECTION AS BEFORE ANOTHER LIMB IS PROGRESS IN AN UNUSUAL DIRECTION Future ?