Thoracic Surgery & Lung Transplant

Department of Thoracic Surgery & Lung Transplant provides services for the surgical treatment of infectious, benign and malignant diseases of the chest. The Thoracic Surgeons at BLK-Max Super Speciality Hospital offer surgical management of a wide range of disorders and diseases involving:

• Lung Transplant 
• Lungs
• Pleura (Chest cavity)
• Trachea and Bronchus (Wind Pipe)
• Esophagus (Food Pipe)
• Chest wall
• Diaphragm
• Mediastinum
• Chest Trauma
• Hyperhidrosis (excessive sweating):  Hand/Axilla

Techniques of Surgeries

Conventionally Thoracic Surgeries have been done by making large incisions over the chest, cutting through all the muscles, applying a special retractor to spread the ribs or splitting/cutting the breast bone to get into the chest and thereafter perform these operations. These large incisions may cause immense trauma, which may cause excessive pain, delayed recovery and higher rates of post-operative complications. We at our centre perform most of these procedures by minimally invasive techniques, VATS (Video Assisted Thoracic Surgery) and RATS (Robotic Assisted Thoracic Surgery).

Open Chest Surgery
Thoracic surgery has been performed traditionally through a Thoracotomy, already explained in the paragraph above. The incision is approximately 15-20 cm and often results in the need to spread the ribs to get for adequate visualization. Many a procedures are still performed through this approach depending upon the necessity /indications.

Video-Assisted Thoracoscopic Surgery (VATS)
VATS is synonymous with Minimally Invasive Thoracic Surgery/Thoracoscopic Surgery. This is performed by introducing a small camera and instruments through single/multiple tiny cuts over the Chest wall. VATS enable excellent visualization, performing Surgery in sick and elderly patients who have marginal pulmonary reserve. VATS avoids excessive pain and results in faster recovery of the patient. In present scenario most of the procedures can be performed with equal/better results with VATS.

Robotic Assisted Thoracic Surgery (RATS)
Robotic Thoracic Surgery is an integral part at BLK-Max Super Speciality Hospital. We offer the latest cutting-edge technology (Da Vinci Xi Robotic System), providing the best outcome. Robotic technology provides better optics and instrument manoeuvrability, allowing the Surgeon to perform technically demanding complex operations with great precision and ease

Lung Transplantation

Indications for Lung Transplantation
The primary indication for lung transplantation is the presence of end-stage lung disease that is unresponsive to other medical treatments. Patients typically experience severe limitations in daily activities, leading to a poor quality of life. Lung transplantation is generally considered when a patient's prognosis is bleak, often quantified by a 20% chance of survival over the next one year without intervention.

Diseases such as COPD are the leading causes for lung transplants, accounting for a significant percentage of cases. Other conditions like Pulmonary Hypertension and Cystic Fibrosis also qualify patients for this procedure. The decision to proceed with transplantation involves a thorough evaluation, including assessing the patient's overall health, the likelihood of post-transplant recovery, and their ability to adhere to the stringent post-operative care regimen.

The Transplant Process
At the core of the lung transplantation process is finding a suitable donor. Due to the limited availability of donor organs, many patients remain on the waiting list for extended periods. The National Organ sharing organization of the country maintains a list of potential recipients and matches them with available donor lungs based on medical urgency and compatibility.

The transplantation process begins once a donor is identified, and a suitable recipient match is found in the Waiting List. The Surgery typically lasts several hours and involves removing the diseased lung and replacing them with the healthy donor lung. Post-operative care is crucial and often requires an extended hospital stay to monitor for complications, such as infection or organ rejection.

Post-Transplant Challenges
While lung transplantation can dramatically improve quality of life and increase survival rates, it is not without challenges. One of the primary concerns is the risk of organ rejection, which occurs when the recipient's immune system identifies the new lung as a foreign object. To combat this, patients must take immunosuppressive medications for the rest of their lives, which can increase vulnerability to infections and other complications.

Further, the mental and emotional brunt of lung transplantation cannot be overlooked. Many patients experience anxiety and depression as they adjust to their new lives. Support from healthcare providers, family, and support groups is essential in helping patients navigate these challenges.

Conditions We Treat 

Lung Diseases

Bronchiectasis
Bronchiectasis is defined as permanent & irreversible enlargement of the airways of the lung, mainly peripheral ones. Bronchiectasis can present as both acquired and congenital (since birth), can be due to tuberculosis or other bacterial infections. Removal (Surgical) of the diseased part lung cures patients not responding to medical treatment. We do these surgeries by VATS/RATS techniques also depending upon the lesion characteristics.

Aspergilloma
Aspergilloma also known as mycetoma or fungus ball, occurs in patients with pre-existing cavitary lung diseases such as Tuberculosis. Medical treatment is usually not effective in these patients. The most problematic complaint in these patients is Hemoptysis (coughing out blood). Surgical removal of diseased lung in symptomatic patients (even asymptomatic) provides permanent cure. 

Hydatid Cyst in Lung
Hydatid Disease is a common protozoal disease in India. Lung is the second most common organ involved, next to liver. It’s a common parasitic infestation by  Tapeworm of the genus Echinococcus occurring in lungs. Treatment of choice is surgical removal of the diseased part  of lung along with medical treatment.

Lung bullae and blebs
Bullae are thin walled sacks in lung filled with air, likely to burst because of their fragility. Smaller sized ones are termed blebs. If ruptured, the entire lung collapses and leads to pneumothorax. Pneumothorax is treated by immediate placement of a tube (intercostal lung drain). Surgery is indicated in patients with: large bullae causing breathlessness, increasing size of bulla, recurrent pneumothorax, infected bullae not responding to medical treatment. We offer VATS surgery to these patients with excellent outcomes.

Emphysema (Lung Volume Reduction Surgery)
Lung Volume Reduction Surgery (LVRS) is a surgical procedure aimed to remove diseased (emphysematous lung tissue) allowing the expansion of the remaining normal lung. LVRS is also a bridge procedure for lung transplant in selected patients.

Lung Nodules
Lung nodule are mass lesions, usually is seen on a Chest X-ray or a CT scan in a person with respiratory illness. Nodules seen in lungs can be due to various causes ranging from infections to cancer. Though these are categorised in two main types: Malignant (Cancerous) and Benign (NonCancerous). Benign Pulmonary nodules can have a wide variety of causes. Our team evaluates and treats patients having lung nodules. The lung nodule will be excised/biopsied by VATS.

Pleural Cavity
The Pleural Cavity is small space present between the pleura, visceral and parietal pleura are the two thin membranes that line and surround the lungs.

Empyema Thoracis
Empyema is defined as collection of pus in the pleural space. Common causes for Empyema are Tuberculosis, Pneumonia, etc. A peel forms over the lung surface and inner lining of chest in few diseases, which restricts the expansion of lung. VATS/Open Decortication removes all the pus along with the peel from the chest cavity allowing the lung to expand.

Drainage & Control of Hemothorax
Collection of  Blood between the Chest wall and the Lungs, most commonly due to chest Injury. Hemothorax is initially treated by inserting a tube in chest cavity and thereafter evaluated and treated accordingly. In case not drained completely, would need surgical drainage. Broken ribs, if present are also fixed during the surgery.

Pneumothorax
A Pneumothorax occurs when air leaks into the space between lungs and Chest wall. This air pushes on the outside of the lung and collapses it. Pneumothorax can lead to complete or partial lung collapse. There are multiple causes of pneumothorax, which can be a blunt or penetrating chest injury, certain medical procedures, or damage/burst of underlying lung disease.

Diagnostic Thoracoscopy
Diagnostic Thoracoscopy is a procedure done to establish a diagnosis in patients with undiagnosed Pleural Effusions. It allows direct visual assessment of the pleura and subsequent biopsy of visually abnormal areas, thereby maximising diagnostic yield. Thoracoscopy can be performed either under General Anaesthesia or under sedation with Local Anaesthesia. 

Chylothorax
Leakage of lymphatic fluid from the thoracic duct or any of its tributaries in thoracic cavity is referred as Chylothorax. Chylothorax occurs mostly post-traumatic, post-surgical intervention or in lymphatic disorders/lymphoma. Thoracoscopic/VATS ligation of the thoracic duct provides a safe & effective treatment of chylothorax.  

Mediastinum
Mediastinum is the central portion in thoracic cavity divided into three parts, namely anterior, middle & posterior area in reference to Heart. Anterior part contains Thymus Gland and Lymphatics, middle portion mainly Heart and posterior has the Oesophagus and Trachea, and other neuro-lymphoid structures.

Myasthenia Gravis
Myasthenia Gravis is not so uncommon autoimmune disorder, characterized mainly by weakness and rapid fatigue of any of the voluntary muscles. Around 10-15% of patients suffering from Myasthenia Gravis might concomitantly have Thymoma. Another 60%, however, will have other abnormalities of the gland including Thymic Hyperplasia (an enlarged gland). Thymectomy has been a mainstay in the surgical treatment of Myasthenia Gravis and helps over 85% of Myasthenia Gravis patients. We do Thymectomy/Thymothymectomy by VATS/ Minimally Invasive /Robotic techniques.

Thymoma
Thymoma is a tumor of Thymus Gland. Patients with Thymoma may also have other Autoimmune Disease (like Myasthenia, pure Red Cell Aplasia). Most of the patients don’t have any symptoms and the tumor is detected incidentally. Thymo-Thymectomy (Complete Surgical Removal) is recommended  in these patients, and helps in  long term cure of these patients. We offer VATS/Subxiphoid VATS/ RATS (Robotic Surgery) to these patients with excellent outcomes.

Mediastinal Masses
A variety of cysts and tumors in mediastinum are broadly termed as the mediastinal masses. The causes vary by patient age, location of the mass (anterior, middle, or posterior mediastinum) and many a times symptoms also. The tumors are often discovered incidentally on a Chest X-Ray/ CT scan which is performed for some another reason. Disease specific symptoms present late and are often a result of the compression of surrounding structures, such as the Spinal Cord, Heart or the Pericardium (the Heart’s lining), etc. Tumors of posterior (back) mediastinum can cause compression of the Spinal Cord earlier. Almost 40% of people who have mediastinal tumors experience no symptoms in early stage/phase. Mediastinal Tumors (both benign and malignant) should be treated with a curative intent by Surgery/Radiotherapy/Chemotherapy. The ones that are left untreated can cause serious complications including invading the Heart, Pericardium (the lining around the heart), and great vessels (the Aorta and Vena Cava). Treatment depends on the cause/histopathological diagnosis. Surgical resection is treatment of choice in resectable/early tumors. Though a few are to be treated by Chemotherapy, such as Lymphomas, some by Radiotherapy.

Esophageal Diverticula:
Diverticula are small pouches that form in the Esophagus or its side. These may be acquired or even since birth. Almost all patients are unaware of these pouches until they get filled with food and become inflamed or infected, condition described as Diverticulitis. Symptoms can be quite varied, which maybe difficulty in swallowing, occasional heartburn, regurgitation of food, rarely hoarseness, repeated pneumonia/fever, and then even have repeated episodes of inhaling food into airway or lungs. We offer key-hole surgery to these patients with excellent outcomes.

Airway (Trachea & Bronchus)
Unlike other areas in chest cavity, most problems of Trachea/Bronchi in adults are surgical managed. Blockage of the Airway (Complete/Partial stenosis) is quite common in airway  and therefore may lead to breathlessness/collapse of lung. Multidisciplinary experts at BLK-Max Super Speciality Hospital are experienced in selecting the appropriate treatments for patients with Tracheal and Bronchial problems. Treatment may include Surgical Excision, Bronchoscopic treatments  alone or in combination. Airway diseases are also seen and most of them are treated surgically, like Tracheal Stenosis, Trachea-Bronchomalacia and Tracheo-Esophageal Fistula.

Pericardium
The Pericardium is a very thin sac that surrounds the heart and origin of great vessels. It protects the Heart and provides the lubrication for the Heart with the help of pericardial fluid.

Constrictive Pericarditis
Constrictive Pericarditis is caused by long-term inflammation of the Pericardium. Inflammation in Pericardium over a period of time causes scarring, thickening, and muscle tightening, or contracture. If it is left untreated, a rigid Pericardium can lead to compression and thereafter Heart failure, which may even be life-threatening. Most common cause is Tuberculosis. There are effective treatments for the condition. The definitive treatment for Constrictive Pericarditis is Pericardiectomy which is a surgical procedure where the entire Pericardium is peeled away from the heart, allowing unrestricted the heart motions.

Pericardial Window
A window of around 2x2 inches in size is made to drain the excessive fluid around the Heart. It can also help diagnosing the source of the extra fluid. Conditions that might need a Pericardial Window are Metastatic Cancers, Immune System Disease and metabolic causes, like Kidney Failure with Uremia. We perform Pericardial Window by Key-hole Technique/ VATS in these patients with excellent outcomes.

Diaphragm
Diaphragm is a dome-shaped, muscular and membranous structure that separates the Thoracic (chest) from the abdominal cavity. It functions as the primary muscle of respiration. As the Diaphragm contracts, the volume of the Thoracic cavity increases and air is drawn into the Lungs.

Eventration & paralysis of diaphragm
Diaphragmatic eventration is used to describe a condition of relaxation of the Diaphragmatic dome, making it tent upwards towards the apex of Thoracic cavity. It may even present at birth as a congenital condition due to an anomaly in Diaphragmatic development. It may even present later in the life as an acquired condition (‘Acquired Diaphragmatic Paralysis’ or ‘Acquired Diaphragmatic Elevation’).

The patients may have complaint of breathlessness, cough or chest pain, mainly on exertion. The goal of surgical correction is to place the diaphragmatic leaflet in a position of maximum inspiration which relieves compression on the lower part of lung parenchyma and allows its re-expansion. We use Minimally Invasive Surgery (VATS Plication)/Robotic Plication for treating these patients with excellent outcomes.

Diaphragmatic Hernia
Diaphragmatic Hernia can be simply defined as defect/rent in Diaphragm leading to abdominal structures pushing into Thoracic cavity. This can be a result of some injury /trauma, post-surgery or maybe present since birth (congenital defect). These hernias have to be repaired irrespective of symptomatic or not. We perform these surgeries in Minimally Invasive/VATS/Robotic Techniques. 

Chest Wall
The Chest Wall is also known as Thoracic Wall, is the boundary of the Thoracic cavity. Chest Wall refers to the rigid framework made up of bones and muscles along with other soft tissues. This bony cage protects various organs in the chest. 

Chest Trauma
Chest has the most vital structures of the body and is unfortunately a common affected site during road traffic accidents, stab and gun-shot injures. While in a  large  percentage of patients, these injuries are fatal on the spot, many other many patients reach hospital in a critical state and need immediate treatment for injuries. These injuries may comprise of one to many rib fractures, fracture of sternum (breast bone), injury to lungs leading to Hemothorax (collection of blood around the lungs) or Pneumothorax (air around the lungs), injury to Trachea (wind-pipe), Esophagus (food pipe), Diaphragm (layer between the chest and the stomach).

Chest Wall Deformities
There are structural abnormalities/deformities of the chest wall. 

• Pectus Excavatum (sunken or funnel chest)
• Pectus Carinatum (pigeon chest)

We use minimally invasive techniques (NUSS technique) and Ravitch procedure to correct these deformities as per the indication.

Infections/Sinuses
Infection may occur in soft tissue, cartilage and bones of chest wall. Treatment depends on aetiology, location and magnitude of infection. Treatment may range from use of antibiotics/medicines to surgical resection of devitalized tissue and subsequent coverage with well vascularized soft tissue flap. 

Palmar-Plantar Hyperhidrosis
Hyperhidrosis is a medical condition characterised by abnormal and excessive sweating from a palms and soles. Such an excessive sweating not only disrupts normal daily activities, this causes social anxiety and embarrassment. It is a medical condition wherein the patients aren’t able to join armed forces, also makes their professional life (in few selected fields) virtually impossible.