CARDIOTHORACIC SURGERY

Lung/ Thoracic Surgery

Over 26 million adults in the US have a chronic lung disease such as COPD, asthma, pulmonary fibrosis or lung cancer. It is the third leading cause of death in both men and women in the United States.

Thoracic surgery is performed to examine and/or treat diseases of the lungs and other structures in the chest cavity or thorax.

Lung & Thoracic procedures and conditions treated by Dr. Bradford

Lung Mass/ Lung Resection/ Lung Cancer

The lungs are subdivided into lobes, anatomic divisions. There are three lobes on the right side: upper, middle and lower, and two on the left side: upper and lower. Because the heart is mostly on the left side, the left lung is smaller than the right.

Lung Mass- the exact location and size of the mass can be measured, and other areas can be examined to check whether a cancerous mass has spread. If the mass needs to be removed, its size, location, and spread determine how much of the surrounding lung also needs to be removed. Removal of the diseased part or all of a lung is called lung resection.

Lung Mass

the exact location and size of the mass can be measured, and other areas can be examined to check whether a cancerous mass has spread. If the mass needs to be removed, its size, location, and spread determine how much of the surrounding lung also needs to be removed. Removal of the diseased part or all of a lung is called lung resection.

Lung Cancer

Lung cancer is the leading cause of cancer related mortality. Today, however, there is more hope than ever for lung cancer patients thanks to numerous improvements in diagnosis and treatment, including several surgical advances.

Dr. Bradford is highly trained and experienced in both open (thoracotomy) and minimally invasive (thoracoscopy) surgical options for lung cancer.

Depending on the type and stage of the lung cancer, surgery can remove the tumor along with the diseased part of the lung. This is the most common option when the cancer has not spread. There are four types of lung surgeries:

LobectomyLobectomy- removes an entire lobe.

PneuomectoyPneumonectomy- removes an entire lung.

Wedge ResectionWedge Resection- removes a small portion of a lobe.

Wedge ResectionSegmentectomy- removes a larger portion of a lobe.

These surgeries are performed by either thoracoscopy or thoracotomy.

Collapsed lung/ Pneumothorax

A pneumothorax (noo-mo-THOR-acks) is a collapsed lung. Pneumothorax occurs when air leaks into the space between your lungs and chest wall. This air pushes on the outside of your lung and makes it collapse. In most cases, only a portion of the lung collapses.

When the lung collapses, it causes sudden chest pain and shortness of breath. Surgery may be necessary to close the air leak in which the surgeon will look for the leaking bleb and sew it closed. If no leaking bleb is visible, a substance like talc is blown in through the tube to irritate the tissues around the lung so that they'll stick together and seal any leaks.

Damaged lung tissue is more likely to collapse.

Mediastinal Tumors/ Esophageal Disorders

Mediastinal masses are caused by a variety of cysts and tumors. The mediastinum is the part of your chest cavity that separates your lungs. Your heart, aorta, esophagus, thymus (one of your glands), trachea, lymph nodes, and nerves are contained within the mediastinum, which is bordered by your sternum (breastbone) in front, your spine in back, and your lungs on either side.

Mediastinal tumors are growths that form in this area. They can be cancerous (malignant) or non-cancerous (benign). Whether tumors are malignant or benign, Dr. Bradford is experienced in all the different approaches to surgical resection of mediastinal masses and lymph node removal, including sternotomy, thoracotomy, thoracoscopic, and robotic-assisted approaches.

Sternotomy - the surgeon makes a large incision in the center of your chest and separates the sternum (breastbone) to gain access to your mediastinum. The surgeon then locates and resects the tumor.

Thoracotomy - the surgeon makes an incision on the side, the back, or in some cases, between the ribs to gain access to the chest cavity. The surgeon then locates the tumor and removes it.

Video-Assisted Thorascopic Surgery (VATS) - a minimally invasive alternative to open chest surgery in selected cases that involves less pain and recovery time. After giving you a sedative, the physician will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. The surgeon then locates and removes the tumor or tumors.

Robotic-Assisted Mediastinal Tumor Resection - the surgeon uses a computer-controlled, robotic device that moves, positions, and manipulates surgical tools based on the surgeon's movements. The surgeon sits at a computer console with a monitor and the camera provides a three-dimensional view of the heart that is magnified ten times greater than a person's normal vision. The surgeon's hands control the robotic arms to perform the procedure.

Fluid around the lung / Pleural Effusion/ Empyema

Pleural Effusion

A pleural effusion is an abnormal amount of fluid in the thin membrane (pleura) that lines the surface of the lungs and the inside of the chest wall outside the lungs. In normal conditions, only a small amount of watery fluid is present in the pleural, allowing the lungs to move smoothly within the chest cavity during breathing. Most pleural effusions are not serious by themselves, but some require treatment to avoid problems.

Empyema

Empyema is a pleural effusion that is infected. This type of fluid collection (pus) in the pleura is caused by a bacterial infection that spreads from the lung such as pneumonia, a lung abscess, and bronchiectasis.

Numerous medical conditions can cause pleural effusions. Some of the more common causes are:

  • Congestive Heart Failure
  • Pneumonia
  • Liver Disease (Cirrhosis
  • End-Stage Renal Disease
  • Nephrotic Syndrome
  • Cancer
  • Pulmonary Embolism
  • Lupus and Other Autoimmune Conditions

Dr. Bradford specializes in minimally invasive surgery for pleural effusions:

Video-assisted thoracoscopic surgery (VATS)

A minimally-invasive approach that is completed through 1 to 3 small (approximately ½ -inch) incisions in the chest. Also known as thoracoscopic surgery, this procedure is effective in managing pleural effusions that are difficult to drain or recur due to malignancy. Sterile talc or an antibiotic may be inserted at the time of surgery to prevent the recurrence of fluid build-up.

Thoracotomy (Also referred to as traditional, “open” thoracic surgery)

A thoracotomy is performed through a 6- to 8-inch incision in the chest and is recommended for pleural effusions when infection is present, empyema. A thoracotomy is performed to remove all of the fibrous tissue and aids in evacuating the infection from the pleural space. Patients will require chest tubes for 2 to 4 weeks after surgery to continue draining fluid.

Gastroesophageal Reflux Disease (GERD)/ Hiatal Hernia

A hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm. The diaphragm is the muscle wall that separates the stomach from the chest. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The diaphragm helps keep acid from coming up into the esophagus. When you have a hiatal hernia, it's easier for the acid to come up. The leaking of acid from the stomach into the esophagus is called gastroesophageal reflux disease (GERD). GERD may cause symptoms such as:

  • Heartburn
  • Problems Swallowing
  • A Dry Cough
  • Bad Breath

Hiatal hernias are common in people over age 50.

When is surgery a treatment option?

Surgery to reduce the hernia may be needed when the hiatal hernia is in danger of becoming constricted or strangulated (cutting off the blood supply).

Dr. Bradford is highly skilled in minimally invasive hiatal hernia repair which includes smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery. Many patients are able to walk around the next day.

Deformities of the chest/ Pectus Exacavatum

(PE) is an abnormal development of the rib cage where the breastbone (sternum) caves in. This results in a sunken chest wall deformity sometimes referred to as "funnel chest." Pectus excavatum is a deformity often present at birth (congenital) that can be mild or severe.

Pectus excavatum repair surgery

The primary goal of pectus excavatum repair surgery is to correct the chest deformity to improve a patient’s breathing, posture and cardiac function. This is typically accomplished by removing a portion of the deformed cartilage and repositioning the breastbone.

Dr. Bradford offers an advanced treatment option for pectus excavatum called:

Highly Modified Ravitch Technique:

Originally completed by a long incision across the chest to resect excess cartilage, reposition rib bones, and implant a wedge bone graft to correct pectus excavatum, the Ravitch technique has been recently modified as a less-invasive procedure.

The highly modified Ravitch technique is completed with a vertical incision in the mid-chest area to remove anterior cartilage. Two stainless-steel struts are placed across the anterior chest to support the breastbone and are wired to the appropriate ribs on each side, allowing the breast bone to be elevated. The struts are not visible from the outside and are removed after two years during a surgical procedure.

Benefits of this less-invasive procedure include:

  • Shortened hospital stay following the procedure
  • Decreased postoperative pain
  • Reduced Risk of complications

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Sweaty palms / Hyperhidrosis

Hyperhidrosis is a disease that often manifests as severe, localized sweating in the hands and/or armpits. Although sweating is a normal bodily function that helps regulate body temperature in hot weather and during exercise, patients with hyperdidrosis often sweat excessively even in mild weather and at rest. Dr. Bradford has treated focal hyperhidrosis with excellent results.

The leading surgical approach currently available for hyperhidrosis is a procedure called Endoscopic Throracic Sympathectomy (ETS). This minimally invasive technique disables the nerves that control sweating to the problem area. ETS is usually performed as an outpatient procedure that limits pain and reduces your recovery period.

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