The respiratory system is a complex network that begins with the inhalation of air through the nose and mouth, and continues with its passage to the lungs.
When we breathe, air passes through the nose and mouth into the trachea. The trachea divides into two main bronchi, right and left, which continue to divide down to the alveoli, where gas exchange between air and blood takes place.
Within the thoracic cavity, there are two lungs: one on the right and one on the left. Generally, the right lung is divided into three lobes and ten segments, while the left lung is divided into two lobes and nine segments.
The pleura is a thin membrane that covers the surface of the lungs and the inside of the chest wall.
The anatomical region between the lungs is called the mediastinum, and it contains the heart, the main blood vessels (aorta and pulmonary artery, vena cava, and pulmonary veins), lymph nodes, the thymus, the esophagus, the thoracic duct, and important nerves.
The thoracic cavity is formed by the diaphragm, a muscle that separates the thoracic cavity from the abdominal cavity, 12 pairs of ribs, the intercostal muscles, and the sternum.
Surgical approach
Thoracoscopy
Thoracoscopy is a minimally invasive technique that allows access to the lung using a camera and appropriate instruments.Why is the operation necessary?
The patient has a pulmonary pathology that needs to be investigated or treated. Thoracoscopy allows the following operations:
- Diagnosis and treatment of pleural effusions
- Biopsy or removal of certain pleural tumours
- Removal of certain lung nodules
- Lung biopsy
- Treatment of pneumothorax
- Mediastinal lymph node biopsy
- Removal of certain tumours of the mediastinum and thymus
- Major lung resections (lobectomies and pulmonary segmentectomies)
- Thoracic sympathectomy (section of the sympathetic nerve chain)
- Decortication (freeing the lung from fibrinous or tumorous rind)
- Resection of one or more sites of lung disease (cyst, sequestrum, abscess, tumour, etc.)
- Other interventions
Thoracotomy
Thoracotomy is the open technique used to access the thoracic cavity and the lungs.
Why is the operation necessary?
The patient has a pulmonary pathology that needs to be investigated or treated. The thoracotomy allows the following operations to be carried out:
- Removal of certain pleural tumours
- Removal of certain lung nodules
- Mediastinal lymph node biopsy
- Major lung resections (lobectomies, segmentectomies, sleeve or wall resections)
- Decortication (freeing the lung from fibrinous or tumorous rind)
- Resection of one or more sites of lung disease (cyst, sequestrum, abscess, tumour, etc.)
- Closing a fistula
- Other interventions
Sternotomy
Sternotomy is an open technique for accessing the mediastinum.
Why is the operation necessary?
The patient has a mediastinal pathology to be investigated or treated. The sternotomy allows the following operations to be carried out:
- Thymectomy
- Thyroidectomy (for plunging goitre)
- Other interventions
Mediastinoscopy
Mediastinoscopy is the exploration of the mediastinum using a camera called a mediastinoscope.
Why is the operation necessary?
The patient has a pathology of the mediastinum to be investigated or the suspicion of extension into the lymph nodes of a lung tumour or of another origin. Mediastinoscopy makes it possible to take biopsies and examine the mediastinal lymph nodes.
Chamberlain anterior mediastinotomy
Mediastinotomy is an open technique for accessing the mediastinum.
Why is the operation necessary?
The patient has a mediastinal pathology to investigate. This technique makes it possible to perform a biopsy and obtain tissue samples for diagnostic purposes.
Lung resection
Lobectomy
A lobectomy is the resection of a lobe of the lung. The remaining space will be progressively occupied by the remaining lung.
Why is the operation necessary?
Lobectomy is the 'standard' treatment for the majority of lung cancers in the early or early stages. Certain benign lesions of the lung, depending on their location, can also be resected by this type of operation.
Segmentectomy
Segmentectomy is the resection of a lung segment, a sub-division of the lobe, that removes the segmental vein, artery and bronchus as well as the lung parenchyma.
Why is the operation necessary?
This procedure is indicated for certain small, peripheral cancers or a particular type of tumour with a "ground-glass opacity" image on the thoracic scanner, for some lung metastases and for patients whose respiratory function is impaired and does not allow a lobectomy to be performed.
Wedge resection
Wedge resection is a non-anatomical (does not follow the division of the bronchi), wedge-shaped resection of the lung parenchyma.
Why is the operation necessary?
This operation is indicated for the removal of a nodule of unknown nature, lung metastases or certain benign lesions of the lung.
Sleeve resection
Sleeve resection is the anatomical resection of one or two lobes of the lung with an anastomosis (suture) of the bronchus. Sometimes an anastomosis of the artery is also necessary (double sleeve resection).
Why is the operation necessary?
Sleeve resection is the treatment for central lung cancer and/or cancer that has invaded the proximal bronchus, in order to spare as much lung parenchyma as possible and avoid pneumonectomy.
Pneumonectomy
Pneumonectomy is the complete resection of a lung. The remaining cavity gradually fills with natural serous fluid.
Why is the operation necessary?
As far as possible, the surgeon always tries to avoid a pneumonectomy and therefore to preserve as much lung parenchyma as possible, in order to preserve respiratory function as much as possible and reduce the risk of complications. But some tumours, because of their size or location, may require complete removal of the lung.
Lung volume reduction
Why is the operation necessary?
Lung volume reduction is a palliative treatment for heterogeneous pulmonary emphysema.
Bullectomy
Why is the operation necessary?
The patient presents with emphysema in the form of one or more very localised bullae. Resection of this part of the parenchyma allows the crushed lung to return to its place.
Mediastinal operations
Thymectomie
La thymectomie est l’ablation de la glande du thymus.
Pour quelle raison l’opération est-elle nécessaire ?
La thymectomie est nécessaire en deux cas :
- pour aider au traitement de certaines myasthénies gravis
- pour enlever une tumeur développée dans le thymus
Thyroidectomy
Thyroidectomy is the removal of the thyroid gland.
Why is the operation necessary?
The patient presents with a thyroid goitre that plunges into the mediastinum, causing discomfort or compression of the trachea.
Pleura operations
Chemical pleurodesis
Chemical pleurodesis is an operation that uses talcum powder to create a definitive seal between the two layers of the pleura.
Why is the operation necessary?
The patient may present:
- Recurrent pneumothorax after mechanical pleurodesis or pleurectomy.
- Pneumothorax linked to endometriosis (catamenial).
- Pneumothorax secondary to pulmonary emphysema.
- Malignant pleural effusion.
- A chronic benign pleural effusion.
Mechanical pleurodesis
Mechanical pleurodesis is the operation which allows the creation of a definitive connection between the two layers of the pleura by pleural abrasion.
Why is the operation necessary?
The patient has a persistent or recurrent pneumothorax, or is exposed to significant variations in pressure (scuba diving, aerial sports, etc.).
Pleurectomy
Pleurectomy is the surgical removal of the parietal pleura.
Why is the operation necessary?
In the event of recurrence of pneumothorax after mechanical pleurodesis.
Pleural biopsy by thoracoscopy
This operation allows samples of pleura to be taken using the minimally invasive technique.
Why is the operation necessary?
The patient presents pleural disease, the nature of which remains to be determined. This operation is particularly important if a malignant tumour is suspected.
PleurX
The pleurX is a permanent chest tube, designed to allow fluid evacuation at home on demand.
Why is the operation necessary?
The patient has a malignant pleural effusion for which treatment by chemical pleurodesis is not indicated, either because the patient cannot tolerate the operation, or because the lung is tied up by the disease preventing the two layers of pleura from joining together.
Decortication
Pleuropulmonary decortication is the operation that consists of freeing the lung from the fibrous gangue that surrounds it, in the case of infection or tumour.
Why is the operation necessary?
The patient may have an infection of the pleural cavity (empyema) that does not heal with thoracic drainage and/or drug treatment, or he may have cancer of the pleura (mesothelioma).
Pleurectomy/decortication
This procedure combines pleurectomy, it means surgical removal of the parietal pleura, with decortication, which consists of freeing the visceral pleura from the fibrous tumour gangue that surrounds it.
Why is the operation necessary?
The patient has cancer of the pleura (mesothelioma).
Open pleural biopsy
This operation allows samples of pleura to be taken using the open technique.
Why is the operation necessary?
The patient presents with pleural disease, the nature of which remains to be determined. The examination is particularly important if a malignant tumour such as mesothelioma is suspected. This technique is used mainly in cases where the spaces between the ribs are very tight because of the disease, preventing thoracoscopy.
Chest wall operations
Chest wall resection
Why is the operation necessary?
The patient has a tumour of the chest wall or the chest wall is infiltrated by breast cancer or lung cancer.
Rib osteosynthesis
This is the fixation of one or more rib fractures using plates and screws.
Why is the operation necessary?
The patient has an unstable thorax with rib fractures at several levels (flail chest), or very displaced rib fractures that alter the thoracic cavity, or persistent pain that is refractory to adequate analgesic treatment or poor consolidation of an old fracture (pseudarthrosis).
Correction of the pectus excavatum (Nuss technique)
Why is the operation necessary?
The young patient had a moderate pectus excavatum with a pathological Haller's index (>3.5), which was aesthetically embarrassing and/or had repercussions on cardiac function.
Correction of the pectus carinatum or excavatum (sternochondroplasty)
Why is the operation necessary?
The patient has a pectus carinatum or excavatum which is aesthetically unpleasant.
First rib resection
Why is the operation necessary?
The patient presented with thoracic outlet syndrome refractory to non-surgical treatment.
Diaphragm operations
Diaphragm plication
Diaphragm plication involves folding the diaphragm so that it can be lowered into its original position.
Why is the operation necessary?
The patient had symptomatic diaphragmatic paralysis.
Diaphragm repair
Diaphragm repair is the direct repair of a traumatic rupture of the diaphragm.
Why is the operation necessary?
The patient presents with a traumatic rupture of the diaphragm with or without migration of the abdominal organs.
Resection of the diaphragm and/or pericardium
Why is the operation necessary?
The patient has a lung tumour infiltrating the diaphragm and/or the pericardium.
Others
Sympathectomy
Sympathectomy is the interruption of the sympathetic nerve chain.
Why is the operation necessary?
The patient presents with disabling palmar hyperhidrosis and/or erythrophobia (facial blushing) that is refractory to medical treatment.
Thoracic duct ligation
Thoracic duct ligation is the operation that consists of closing the duct that carries lymph from the abdomen to the left subclavian vein.
Why is the operation necessary?
The patient presented with a chylothorax refractory to conservative treatment with drainage and a low-fat diet.