Surgical Procedures

Thoracic Surgery is dedicated to the prevention, early diagnosis and treatment of (non-cardiac) diseases of the chest.  We provide service to a broad range of thoracic issues, including:

Airway surgery

We have a long-standing interest in surgery of the airway, and successfully perform tracheal resections and have treated some cases of trachea-oesophageal fistula. There is a comprehensive endobronchial airway service which is offered jointly by surgeons and physicians and we are able to offer cryotherapy, endobronchial resection, flexible and rigid bronchoscopy, and stenting.

Bronchoscopy

This is an investigation of the airways, using a bronchoscope (a small flexible telescope). The bronchoscope is passed through your mouth and into your windpipe, so that the surgeon can examine your airways, and take a small sample of tissue (biopsy), to find out what is causing your symptoms. A bronchoscopy is usually carried out under general anaesthetic.

Chest wall surgery

Including cancer resections for lung cancer, primary chest wall tumours and secondary tumours to the chest wall. We have experience of different systems for chest wall stabilisation and reconstruction after surgery.

Complex lung resections

Including sleeve resections, other lung-sparing surgery, chest wall resections and resections involving the heart or great vessels.

Investigation and management of pleural diseases

We offer an 'easy-access pleural service'. Historically many patients with pleural disease would have several procedures before a diagnosis was reached; we are of the opinion that repeated cannulation of the pleural space should not be performed and we encourage referral as early as possible. Our aim in managing pleural space problems is to achieve a diagnosis and to alleviate the problem in as few as steps as possible.

We have expertise in the management of pneumothorax, pleural effusions, empyema and pleural tumors such as mesothelioma. The management of mesothelioma is quite controversial and whenever possible we encourage patients to participate in research both designed to help them and to find out the best treatments for mesothelioma.

Lung cancer

Traditionally it was only cases of early lung cancer that were referred for surgical resection. In addition to these cases we also review many cases of locally advanced lung cancer (T3/T4) or when there is limited spread (N2) and in highly selected patients metastatic disease (M1).

All such cases are discussed in a multi-disciplinary group, and if appropriate we may be able to offer surgery supported by additional treatments such as chemotherapy and radiotherapy. We receive requests for second opinions and also consider patients for surgery when other options may have been unsuccessful.

Lung volume reduction surgery

This established treatment can help some people by removing poorly functioning parts of the lung which allows the rest of the lung to work better and also reduces the effort needed to breath.

Mediastinoscopy

This is an examination of the lymph nodes, using a short endoscope (a small flexible telescope). The endoscope is passed through a small incision made at the base of the neck under the chin. A mediastinoscopy is carried out under general anaesthetic.

Metastasectomy

Some people with mestastases to the chest may benefit from resection of these tumors. Each case is very carefully assessed to allow the best decision to be made for the patient.

Minimal access surgery

If appropriate small incisions are advised. This is performed with the help of small operating telescopes which often give an excellent view and is known as keyhole, ‘video-assisted’ or ‘VAT’ surgery.

Open Lung Biopsy

During an open lung biopsy, a small incision is made in the chest so that samples of tissue (biopsies) can be taken, to find out what is causing your symptoms. This procedure is carried out under a general anaesthetic. A chest drain may need to be inserted following the procedure, to drain fluid or air.

Pectus surgery

We have a particular interest in pectus operations and sometimes operate with plastic surgery colleagues to produce the best results.

Surgery for patients with reduced lung function

Each person is assessed on their own merits. Some patients may have been advised that they are inoperable due to poor lung function. Our approach is try to improve their breathing and other illnesses to see if they can tolerate an operation. If surgery is performed we may advise a lung-sparing approach, and such patients benefit from our experienced specialist intensive and nursing care.

Surgery for the mediastinum

Tumors and cysts occur in the mediastinum and we offer a range of operations.

Thoracic Sarcoma

Sarcomas are a form of tumour which have particular requirements. We work with oncologists who also have a special interest in this area, again with the aim of getting the best results.

Thoracoscopy

This is an investigation of the inside of the chest area, using an endoscope (a small flexible telescope). The endoscope is inserted through the chest wall, so that the surgeon can examine the area, and take a small sample of tissue (biopsy). A thoracoscopy is carried out under general anaesthetic. A chest drain may need to be inserted following this procedure, to drain fluid or air.

Thoracotomy

A thoracotomy is an operation which involves making an incision into the chest wall (thorax). This allows the surgeon to operate on your lung. Some of the procedures the surgeon may carry out include:
LOBECTOMY - the removal of a part (a lobe) of the lung.
PNEUMONECTOMY - the removal of an entire lung.
PLEURECTOMY – the removal of the lining of the chest wall (called the pleura), to allow the lung to ‘stick’ to the chest wall. This procedure is carried out for persistent collapse of the lung (pneumothorax).
DECORTICATION - the removal of any pus or debris from the lining of the lung. This procedure is carried out under general anaesthetic.