Cardiothoracic surgery is the
field
Field may refer to:
Expanses of open ground
* Field (agriculture), an area of land used for agricultural purposes
* Airfield, an aerodrome that lacks the infrastructure of an airport
* Battlefield
* Lawn, an area of mowed grass
* Meadow, a grass ...
of
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
involved in
surgical treatment of organs inside the
thoracic cavity
The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. There ...
— generally treatment of conditions of the
heart
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
(
heart disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
),
lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s (
lung disease
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side ...
), and other
pleural
The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication bet ...
or
mediastinal structures.
In most countries, cardiothoracic surgery is further
subspecialized into cardiac surgery (involving the heart and the
great vessels
Great vessels are the large vessels that bring blood to and from the heart. These are:
*Superior vena cava
*Inferior vena cava
*Pulmonary arteries
* Pulmonary veins
*Aorta
Transposition of the great vessels is a group of congenital heart defec ...
) and thoracic surgery (involving the lungs,
esophagus
The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...
,
thymus
The thymus is a specialized primary lymphoid organ of the immune system. Within the thymus, thymus cell lymphocytes or ''T cells'' mature. T cells are critical to the adaptive immune system, where the body adapts to specific foreign invaders. ...
, etc.); the exceptions are the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
,
Australia
Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...
,
New Zealand
New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island count ...
, the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, and some
European Union
The European Union (EU) is a supranational political and economic union of member states that are located primarily in Europe. The union has a total area of and an estimated total population of about 447million. The EU has often been des ...
countries such as
Portugal
Portugal, officially the Portuguese Republic ( pt, República Portuguesa, links=yes ), is a country whose mainland is located on the Iberian Peninsula of Southwestern Europe, and whose territory also includes the Atlantic archipelagos of ...
.
Training
A cardiac surgery
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgra ...
typically comprises anywhere from four to six years (or longer) of training to become a fully qualified surgeon. Cardiac surgery training may be combined with thoracic surgery and / or
vascular surgery and called cardiovascular (CV) / cardiothoracic (CT) / cardiovascular thoracic (CVT) surgery. Cardiac surgeons may enter a cardiac surgery residency directly from
medical school
A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, M ...
, or first complete a
general surgery
General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid ...
residency followed by a
fellowship
A fellow is a concept whose exact meaning depends on context.
In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements.
Within the context of higher education ...
. Cardiac surgeons may further sub-specialize cardiac surgery by doing a fellowship in a variety of topics including:
pediatric
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...
cardiac surgery,
cardiac transplantation, adult acquired heart disease, weak heart issues, and many more problems in the heart.
Australia and New Zealand
The highly competitive Surgical Education and Training (SET) program in Cardiothoracic Surgery is six years in duration, usually commencing several years after completing medical school. Training is administered and supervised via a bi-national (Australia and New Zealand) training program. Multiple examinations take place throughout the course of training, culminating in a final fellowship exam in the final year of training. Upon completion of training, surgeons are awarded a Fellowship of the
Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons (RACS) is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand.
Known by its common acronym RACS, it is a not-for-profit organisation, sup ...
(FRACS), denoting that they are qualified specialists. Trainees having completed a training program in General Surgery and have obtained their FRACS will have the option to complete fellowship training in Cardiothoracic Surgery of four year in duration, subject to college approval. It takes around eight to ten years minimum of post-graduate (post-medical school) training to qualify as a cardiothoracic surgeon. Competition for training places and for public (teaching) hospital places is very high currently, leading to concerns regarding
workforce planning
The workforce or labour force is a concept referring to the pool of human beings either in employment or in unemployment. It is generally used to describe those working for a single company or industry, but can also apply to a geographic reg ...
in Australia.
Canada
Historically, cardiac surgeons in
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
completed general surgery followed by a fellowship in CV / CT / CVT. During the 1990s, the Canadian cardiac surgery training programs changed to six-year "direct-entry" programs following medical school. The direct-entry format provides residents with experience related to cardiac surgery they would not receive in a general surgery program (e.g.
echocardiography
An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart.
It is a type of medical imaging of the heart, using standard ultrasound or Doppler ultrasound.
Echocardiography has become routinely used in t ...
,
coronary care unit, cardiac catheterization etc.). Residents in this program will also spend time training in thoracic and
vascular surgery. Typically, this is followed by a fellowship in either Adult Cardiac Surgery, Heart Failure/Transplant, Minimally Invasive Cardiac Surgery, Aortic Surgery, Thoracic Surgery, Pediatric Cardiac Surgery or Cardiac ICU. Contemporary Canadian candidates completing general surgery and wishing to pursue cardiac surgery often complete a cardiothoracic surgery fellowship in the United States. The Royal College of Physicians and Surgeons of Canada also provides a three-year cardiac surgery fellowship for qualified general surgeons that is offered at several training sites including the
University of Alberta
The University of Alberta, also known as U of A or UAlberta, is a public research university located in Edmonton, Alberta, Canada. It was founded in 1908 by Alexander Cameron Rutherford,"A Gentleman of Strathcona – Alexander Cameron Rutherfor ...
, the
University of British Columbia
The University of British Columbia (UBC) is a public university, public research university with campuses near Vancouver and in Kelowna, British Columbia. Established in 1908, it is British Columbia's oldest university. The university ranks a ...
and the
University of Toronto
The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
.
Thoracic surgery is its own separate 2–3 year fellowship of general or cardiac surgery in Canada.
Cardiac surgery programs in Canada:
*
University of Alberta
The University of Alberta, also known as U of A or UAlberta, is a public research university located in Edmonton, Alberta, Canada. It was founded in 1908 by Alexander Cameron Rutherford,"A Gentleman of Strathcona – Alexander Cameron Rutherfor ...
– 1 position
*
University of British Columbia
The University of British Columbia (UBC) is a public university, public research university with campuses near Vancouver and in Kelowna, British Columbia. Established in 1908, it is British Columbia's oldest university. The university ranks a ...
– 1 position
*
University of Calgary
The University of Calgary (U of C or UCalgary) is a public research university located in Calgary, Alberta, Canada. The University of Calgary started in 1944 as the Calgary branch of the University of Alberta, founded in 1908, prior to being ins ...
– 1 position
*
Dalhousie University
Dalhousie University (commonly known as Dal) is a large public research university in Nova Scotia
Nova Scotia ( ; ; ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the fou ...
– 1 position every other year
*
Université Laval
Université Laval is a public research university in Quebec City, Quebec, Canada. The university was founded by royal charter issued by Queen Victoria in 1852, with roots in the founding of the Séminaire de Québec in 1663 by François de Montmo ...
– 1 position every three years
*
University of Manitoba
The University of Manitoba (U of M, UManitoba, or UM) is a Canadian public research university in the province of Manitoba.[McGill University
McGill University (french: link=no, Université McGill) is an English-language public research university located in Montreal, Quebec, Canada. Founded in 1821 by royal charter granted by King George IV,Frost, Stanley Brice. ''McGill Universit ...](_blank)
– 1 position every three years
*
McMaster University
McMaster University (McMaster or Mac) is a public research university in Hamilton, Ontario, Canada. The main McMaster campus is on of land near the residential neighbourhoods of Ainslie Wood and Westdale, adjacent to the Royal Botanical Ga ...
– 1 position every other year
*
Université de Montréal
The Université de Montréal (UdeM; ; translates to University of Montreal) is a French-language public research university in Montreal, Quebec, Canada. The university's main campus is located in the Côte-des-Neiges neighborhood of Côte-de ...
– 1 position every three years
*
University of Ottawa
The University of Ottawa (french: Université d'Ottawa), often referred to as uOttawa or U of O, is a bilingual public research university in Ottawa, Ontario, Canada. The main campus is located on directly to the northeast of Downtown Ottawa ...
– 1 position
*
University of Toronto
The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
– 1 position
*
Western University – 1 position
United Kingdom
In the United Kingdom, cardiac surgeons are trained by direct specialty training or through core surgical training. Through the core surgical training route, trainees can apply on their third year for specific training in cardiothoracic surgery. Thereafter, they may choose to subspecialise in areas such as aortic surgery, adult cardiac surgery, thoracic surgery, paediatric cardiothoracic surgery, and adult congenital surgery.
United States
![Surgeon operating, Fitzsimons Army Medical Center, circa 1990](https://upload.wikimedia.org/wikipedia/commons/4/41/Surgeon_operating%2C_Fitzsimons_Army_Medical_Center%2C_circa_1990.JPEG/1200px-Surgeon_operating%2C_Fitzsimons_Army_Medical_Center%2C_circa_1990.JPEG)
Cardiac surgery training in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
is combined with general
thoracic surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal stru ...
and called cardiothoracic surgery or thoracic surgery. A cardiothoracic surgeon in the U.S. is a physician (
M.D.
Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. ...
or
D.O.
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...
) who first completes a
general surgery
General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid ...
residency (typically 5–7 years), followed by a cardiothoracic surgery fellowship (typically 2–3 years). The cardiothoracic surgery fellowship typically spans two or three years, but certification is based on the number of surgeries performed as the operating surgeon, not the time spent in the program, in addition to passing rigorous board certification tests. Two other pathways to shorten the duration of training have been developed: (1) a combined general-thoracic surgery residency consisting of four years of general surgery training and three years of cardiothoracic training at the same institution and (2) an integrated six-year cardiothoracic residency (in place of the general surgery residency plus cardiothoracic residency), which have each been established at many programs (over 20). Applicants match into the integrated six-year (I-6) programs directly out of medical school, and the application process has been extremely competitive for these positions as there were approximately 160 applicants for 10 spots in the U.S. in 2010. As of May 2013, there are 20 approved programs, which include the following:
Integrated six-year Cardiothoracic Surgery programs in the United States:
*
Medical College of Wisconsin
The Medical College of Wisconsin (MCW) is a private medical school, pharmacy school, and graduate school of sciences headquartered in Milwaukee, Wisconsin. The school was established in 1893 and is the largest research center in eastern Wisconsin ...
*
Stanford University
Stanford University, officially Leland Stanford Junior University, is a private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. Stanford is consider ...
– two positions
*
University of North Carolina at Chapel Hill
A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States ...
*
University of Virginia
The University of Virginia (UVA) is a Public university#United States, public research university in Charlottesville, Virginia. Founded in 1819 by Thomas Jefferson, the university is ranked among the top academic institutions in the United S ...
*
Columbia University
Columbia University (also known as Columbia, and officially as Columbia University in the City of New York) is a private research university in New York City. Established in 1754 as King's College on the grounds of Trinity Church in Manhatt ...
– two positions
*
University of Pennsylvania
The University of Pennsylvania (also known as Penn or UPenn) is a private research university in Philadelphia. It is the fourth-oldest institution of higher education in the United States and is ranked among the highest-regarded universitie ...
*
University of Pittsburgh
The University of Pittsburgh (Pitt) is a public state-related research university in Pittsburgh, Pennsylvania. The university is composed of 17 undergraduate and graduate schools and colleges at its urban Pittsburgh campus, home to the universit ...
– two positions
*
University of Washington
The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington.
Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seattle a ...
*
Northwestern University
Northwestern University is a private research university in Evanston, Illinois. Founded in 1851, Northwestern is the oldest chartered university in Illinois and is ranked among the most prestigious academic institutions in the world.
Charte ...
*
Mount Sinai Hospital, New York
Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. It is located in East Harlem in the New York City borough of Manhattan, on the eastern border of Central Park stretching along Madis ...
*
University of Maryland
The University of Maryland, College Park (University of Maryland, UMD, or simply Maryland) is a public land-grant research university in College Park, Maryland. Founded in 1856, UMD is the flagship institution of the University System of M ...
*
University of California, Los Angeles
The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California St ...
UCLA
The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California St ...
– two resident positions, one Transplant Fellowship; one Congenital resident position
*
University of Texas Health Science Center at San Antonio
The University of Texas Health Science Center at San Antonio (UT Health San Antonio) is a public academic health science center in San Antonio, Texas. It is part of the University of Texas System.
UT Health San Antonio is the largest health scie ...
*
Medical University of South Carolina
The Medical University of South Carolina (MUSC) is a public medical school in South Carolina. It opened in 1824 in Charleston as a small private college aimed at training physicians and has since established hospitals and medical facilities ac ...
*
University of Southern California
The University of Southern California (USC, SC, or Southern Cal) is a Private university, private research university in Los Angeles, California, United States. Founded in 1880 by Robert M. Widney, it is the oldest private research university in C ...
– two positions
*
University of Rochester
The University of Rochester (U of R, UR, or U of Rochester) is a private university, private research university in Rochester, New York. The university grants Undergraduate education, undergraduate and graduate degrees, including Doctorate, do ...
*
University of California, Davis
The University of California, Davis (UC Davis, UCD, or Davis) is a public land-grant research university near Davis, California. Named a Public Ivy, it is the northernmost of the ten campuses of the University of California system. The institut ...
*
Indiana University
Indiana University (IU) is a system of public universities in the U.S. state of Indiana.
Campuses
Indiana University has two core campuses, five regional campuses, and two regional centers under the administration of IUPUI.
*Indiana Universit ...
*
University of Kentucky
The University of Kentucky (UK, UKY, or U of K) is a Public University, public Land-grant University, land-grant research university in Lexington, Kentucky. Founded in 1865 by John Bryan Bowman as the Agricultural and Mechanical College of Kentu ...
*
Emory University
Emory University is a private research university in Atlanta, Georgia. Founded in 1836 as "Emory College" by the Methodist Episcopal Church and named in honor of Methodist bishop John Emory, Emory is the second-oldest private institution of ...
*
University of Michigan
, mottoeng = "Arts, Knowledge, Truth"
, former_names = Catholepistemiad, or University of Michigania (1817–1821)
, budget = $10.3 billion (2021)
, endowment = $17 billion (2021)As o ...
The
American Board of Thoracic Surgery The American Board of Thoracic Surgery is an American surgical organization devoted to surgery of the chest.pericardium
The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...
(the sac that surrounds the heart) took place in the 19th century and were performed by
Francisco Romero (1801)
Dominique Jean Larrey
Baron Dominique Jean Larrey (; 8 July 1766 – 25 July 1842) was a French surgeon and military doctor, who distinguished himself in the French Revolutionary Wars and the Napoleonic Wars. An important innovator in battlefield medicine and triage, ...
,
Henry Dalton
Henry Clay Dalton (May 7, 1847 – November 3, 1911) was superintendent of the St. Louis City Hospital, Missouri, United States, from 1886 to 1892, and later a professor of abdominal and clinical surgery at Marion Sims College of Medicine (now pa ...
, and
Daniel Hale Williams
Daniel Hale Williams (January 18, 1856 – August 4, 1931) was an African-American surgeon, who in 1893 performed what is referred to as "the first successful heart surgery". It was performed at Chicago's Provident Hospital, which he founded i ...
. The first surgery on the heart itself was performed by
Norwegian
Norwegian, Norwayan, or Norsk may refer to:
*Something of, from, or related to Norway, a country in northwestern Europe
* Norwegians, both a nation and an ethnic group native to Norway
* Demographics of Norway
*The Norwegian language, including ...
surgeon
Axel Cappelen
Axel Hermansen Cappelen (20 July 1858 – 13 November 1919) was a Norwegian surgeon.
He was born in Selje as a son of district physician Johan Nicolay Cappelen (1818–1890) and Elisabeth Brunchorst Ravn (1825–1906). His brother Christian was ...
on 4 September 1895 at
Rikshospitalet
Oslo University Hospital, Rikshospitalet is one of the four main campuses of Oslo University Hospital in Oslo, Norway. It was an independent hospital, ''Rigshospitalet'', later spelled ''Rikshospitalet'' ("The National Hospital"), from 1826 to 200 ...
in Kristiania, now
Oslo
Oslo ( , , or ; sma, Oslove) is the capital and most populous city of Norway. It constitutes both a county and a municipality. The municipality of Oslo had a population of in 2022, while the city's greater urban area had a population of ...
. He
ligated a bleeding
coronary artery
The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ ...
in a 24-year-old man who had been stabbed in the left
axilla
The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...
and was in deep
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
upon arrival. Access was through a left
thoracotomy
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the hea ...
. The patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the
post mortem
An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any dis ...
proved to be
mediastinitis
Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either Acute (medical), acute or Chronic (medical), chronic. It is thought to be due to four different etiologies:
* direct contamination
* hematogenous or Ly ...
on the third postoperative day. The first successful surgery of the heart, performed without any complications, was by
Ludwig Rehn
Ludwig Wilhelm Carl Rehn (13 April 1849, Bad Sooden-Allendorf – 29 May 1930) was a German surgeon. Rehn was born in 1849, in the village of Allendorf, the youngest of five children. After the visiting the convent school in Bad Hersfeld, he studi ...
of
Frankfurt
Frankfurt, officially Frankfurt am Main (; Hessian: , "Frank ford on the Main"), is the most populous city in the German state of Hesse. Its 791,000 inhabitants as of 2022 make it the fifth-most populous city in Germany. Located on its na ...
,
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
, who repaired a stab wound to the right
ventricle on September 7, 1896.
Surgery in
great vessels
Great vessels are the large vessels that bring blood to and from the heart. These are:
*Superior vena cava
*Inferior vena cava
*Pulmonary arteries
* Pulmonary veins
*Aorta
Transposition of the great vessels is a group of congenital heart defec ...
(
aortic coarctation
Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word ''coarctation' ...
repair,
Blalock-Taussig shunt creation, closure of
patent ductus arteriosus
''Patent ductus arteriosus'' (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has ...
) became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery. One of the more commonly known cardiac surgery procedures is the
coronary artery bypass graft (CABG), also known as "bypass surgery." In this procedure, vessels from elsewhere in the patient's body are harvested, and grafted to the coronary arteries to bypass blockages and improve the blood supply to the heart muscle.
Early approaches to heart malformations
In 1925 operations on the
heart valve
A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart v ...
s were unknown.
Henry Souttar
Sir Henry Sessions Souttar (14 December 1875 – 12 November 1964) was a British surgeon with a wide breadth of interests. He trained first as a mathematician and engineer. His engineer’s training enabled him to design and make new types of s ...
operated successfully on a young woman with
mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...
. He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar's physician colleagues at that time decided the procedure was not justified and he could not continue.
[Lawrence H Cohn (2007), Cardiac Surgery in the Adult, page 6+]
Cardiac surgery changed significantly after World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
. In 1948 four surgeons carried out successful operations for mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...
resulting from rheumatic fever
Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful jo ...
. Horace Smithy (1914–1948) of Charlotte
Charlotte ( ) is the most populous city in the U.S. state of North Carolina. Located in the Piedmont region, it is the county seat of Mecklenburg County. The population was 874,579 at the 2020 census, making Charlotte the 16th-most populo ...
, revived an operation due to Dr Dwight Harken
Dwight Emary Harken (1910–1993) was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit.
Life
Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees f ...
of the Peter Bent Brigham Hospital
Brigham and Women's Hospital (BWH) is the second largest teaching hospital of Harvard Medical School and the largest hospital in the Longwood Medical Area in Boston, Massachusetts. Along with Massachusetts General Hospital, it is one of the two f ...
using a punch to remove a portion of the mitral valve
The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-w ...
. Charles Bailey (1910–1993) at the Hahnemann Hospital, Philadelphia
Philadelphia, often called Philly, is the largest city in the Commonwealth of Pennsylvania, the sixth-largest city in the U.S., the second-largest city in both the Northeast megalopolis and Mid-Atlantic regions after New York City. Sinc ...
, Dwight Harken
Dwight Emary Harken (1910–1993) was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit.
Life
Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees f ...
in Boston
Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...
and Russell Brock at Guy's Hospital
Guy's Hospital is an NHS hospital in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the King's Health Partners, an academic health science centre.
...
all adopted Souttar's method. All these men started work independently of each other, within a few months. This time Souttar's technique was widely adopted although there were modifications.[
In 1947 ]Thomas Holmes Sellors
Sir Thomas Holmes Sellors (7 April 1902 – 13 September 1987) was a British
British may refer to:
Peoples, culture, and language
* British people, nationals or natives of the United Kingdom, British Overseas Territories, and Crown Dependenci ...
(1902–1987) of the Middlesex Hospital
Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, England. First opened as the Middlesex Infirmary in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally clos ...
operated on a Fallot's Tetralogy
Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are:
*pulmonary stenosis, which is narrowing of the exit from the ri ...
patient with pulmonary stenosis
Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms
Cause
Pulmonic stenosis is usually due to isolated valvula ...
and successfully divided the stenosed pulmonary valve
The pulmonary valve (sometimes referred to as the pulmonic valve) is a valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. It is one of the four valves of the heart and one of the two semilunar v ...
. In 1948, Russell Brock, probably unaware of Sellor's work, used a specially designed dilator in three cases of pulmonary stenosis
Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms
Cause
Pulmonic stenosis is usually due to isolated valvula ...
. Later in 1948 he designed a punch to resect the infundibular muscle stenosis
A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).
''Stricture'' ...
which is often associated with Fallot's Tetralogy
Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are:
*pulmonary stenosis, which is narrowing of the exit from the ri ...
. Many thousands of these "blind" operations were performed until the introduction of heart bypass made direct surgery on valves possible.[Harold Ellis (2000) A History of Surgery, page 223+]
Open heart surgery
Open heart surgery is a procedure in which the patient's heart is opened and surgery is performed on the internal structures of the heart. It was discovered by Wilfred G. Bigelow
Wilfred Gordon "Bill" Bigelow (June 18, 1913 – March 27, 2005) was a Canadians, Canadian cardiac surgery, heart Physicians in Canada, surgeon known for his role in developing the artificial pacemaker and the use of hypothermia in open heart ...
of the University of Toronto
The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
that the repair of intracardiac pathologies was better done with a bloodless and motionless environment, which means that the heart should be stopped and drained of blood. The first successful intracardiac correction of a congenital heart defect
A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...
using hypothermia
Hypothermia is defined as a body core temperature below in humans. Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases. In severe ...
was performed by C. Walton Lillehei
Clarence Walton Lillehei (October 23, 1918 – July 5, 1999), was an American surgeon who pioneered open-heart surgery, as well as numerous techniques, equipment and prostheses for cardiothoracic surgery.
Background
Clarence (often called "W ...
and F. John Lewis
Floyd John Lewis (1916 – September 20, 1993) was an American surgeon who performed the first successful open heart operation, closing an atrial septal defect in a 5-year-old girl, on 2 September 1952. For the next 3 years, Lewis and colleagues ...
at the University of Minnesota
The University of Minnesota, formally the University of Minnesota, Twin Cities, (UMN Twin Cities, the U of M, or Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Tw ...
on September 2, 1952. The following year, Soviet
The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen nation ...
surgeon Aleksandr Aleksandrovich Vishnevskiy conducted the first cardiac surgery under local anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
.
Surgeons realized the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body, particularly to the brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
. The patient needs the function of the heart and lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s provided by an artificial method, hence the term cardiopulmonary bypass
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
. John Heysham Gibbon
John Heysham Gibbon (September 29, 1903 – February 5, 1973) was an American surgeon best known for inventing the heart–lung machine and performing subsequent open-heart surgery, open-heart surgeries which revolutionized heart surger ...
at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an oxygenator
An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or ...
, but he abandoned the method, disappointed by subsequent failures. In 1954 Lillehei realized a successful series of operations with the controlled cross-circulation technique in which the patient's mother or father was used as a 'heart-lung machine
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...
'. John W. Kirklin at the Mayo Clinic
The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...
in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world.
Nazih Zuhdi Nazih is both a given name and a surname. It is an Arabic origin word, (Arabic: نزيه). Notable people with the name include:
Given name
* Nazih Abu Afach (born 1946), Syrian poet and painter
* Nazih Ayubi (1943–1995), Egyptian writer
* Nazih ...
performed the first total intentional hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age , using the total intentional hemodilution machine. In 1985 Zuhdi performed Oklahoma's first successful heart transplant on Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, who had cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
, died from an infection 54 days after surgery.
Modern beating-heart surgery
Since the 1990s, surgeons have begun to perform " off-pump bypass surgery" – coronary artery bypass surgery without the aforementioned cardiopulmonary bypass
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
. In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area in which to connect the conduit vessel that bypasses the blockage; in the U.S., most conduit vessels are harvested endoscopically, using a technique known as endoscopic vessel harvesting Endoscopic vessel harvesting (EVH) is a surgical technique that may be used in conjunction with coronary artery bypass surgery (commonly called a "bypass"). For patients with coronary artery disease, a physician may recommend a bypass to reroute blo ...
(EVH).
Some researchers believe that the off-pump approach results in fewer post-operative complications, such as postperfusion syndrome
Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated wit ...
, and better overall results. Study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role.
Minimally invasive surgery
A new form of heart surgery that has grown in popularity is robot-assisted heart surgery
Robotic surgery are types of surgical procedures that are done using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabi ...
. This is where a machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the surgeon to put his hands inside, it does not have to be bigger than 3 small holes for the robot's much smaller "hands" to get through.
Pediatric cardiovascular surgery
Pediatric cardiovascular surgery is surgery of the heart of children. The first operations to repair cardio-vascular defects in children were performed by Clarence Crafoord in Sweden when he repaired coarctation of the aorta in a 12-year-old boy. The first attempts to palliate congenital heart disease were performed by Alfred Blalock with the assistance of William Longmire, Denton Cooley, and Blalock's experienced technician, Vivien Thomas in 1944 at Johns Hopkins Hospital. Techniques for repair of congenital heart defects without the use of a bypass machine were developed in the late 1940s and early 1950s. Among them was an open repair of an atrial septal defect using hypothermia, inflow occlusion and direct vision in a 5-year-old child performed in 1952 by Lewis and Tauffe. C. Walter Lillihei used cross-circulation between a boy and his father to maintain perfusion while performing a direct repair of a ventricular septal defect in a 4-year-old child in 1954. He continued to use cross-circulation and performed the first corrections of tetratology of Fallot and presented those results in 1955 at the American Surgical Association. In the long-run, pediatric cardiovascular surgery would rely on the cardiopulmonary bypass machine developed by Gibbon and Lillehei as noted above.
Risks of cardiac surgery
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is the incidence of neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
damage. Stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
occurs in 5% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass
Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...
is known as postperfusion syndrome
Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated wit ...
, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to be permanent, but were shown to be transient with no permanent neurological impairment.
In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the EuroSCORE
EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a risk model which allows the calculation of the risk of death after a heart operation. The model asks for 17 items of information about the patient, the state of the heart and t ...
. This takes a number of health factors from a patient and using precalculated logistic regression coefficients attempts to give a percentage chance of survival to discharge. Within the UK this EuroSCORE was used to give a breakdown of all the centres for cardiothoracic surgery and to give some indication of whether the units and their individuals surgeons performed within an acceptable range. The results are available on the CQC website. The precise methodology used has however not been published to date nor has the raw data on which the results are based.
Infection represents the primary non-cardiac complication from cardiothoracic surgery. Infections can include mediastinitis, infectious myo- or pericarditis, endocarditis, cardiac device infection, pneumonia, empyema, and bloodstream infections. ''Clostridium difficile'' colitis can also develop when prophylactic or post-operative antibiotics are used.
Post operative patients of cardiothoracic surgery are at risk of nausea, vomiting, dysphagia and aspiration pneumonia.
Thoracic surgery
A pleurectomy is a surgical procedure in which part of the pleura
The pulmonary pleurae (''sing.'' pleura) are the two opposing layers of serous membrane overlying the lungs and the inside of the surrounding chest walls.
The inner pleura, called the visceral pleura, covers the surface of each lung and dips b ...
is removed. It is sometimes used in the treatment of pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve ...
and mesothelioma
Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium). The most common area affected is the lining of the lungs and chest wall. Less commonly the lining ...
.
Lung volume reduction surgery
Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce mu ...
and emphysema
Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alve ...
patients. Parts of the lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work more efficiently. The beneficial effects are correlated with the achieved reduction in residual volume. Conventional LVRS involves resection of the most severely affected areas of emphysematous, non-bullous
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...
lung (aim is for 20–30%). This is a surgical option involving a mini-thoracotomy
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the he ...
for patients in end stage COPD due to underlying emphysema, and can improve lung elastic recoil Elastic recoil means the rebound of the lungs after having been stretched by inhalation,Sherwood, L. (2007). ''Human Physiology: From Cells to Systems'', 6th ed, Thomson Brooks/Cole, Belmont, CA. or rather, the ease with which the lung rebounds. Wi ...
as well as diaphragmatic function.
The National Emphysema Treatment Trial (NETT) was a large multicentre study (N = 1218) comparing LVRS with non-surgical treatment. Results suggested that there was no overall survival advantage in the LVRS group, except for mainly upper-lobe emphysema + poor exercise capacity, and significant improvements were seen in exercise capacity in the LVRS group. Later studies have shown a wider scope of treatment with better outcomes.
Possible complications of LVRS include prolonged air leak (mean duration post surgery until all chest tube
A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the mediastinum in order to remove clinically undesired substance ...
s removed is 10.9 ± 8.0 days.
In people who have a predominantly upper lobe emphysema, lung volume reduction surgery could result in better health status and lung function, though it also increases the risk of early mortality and adverse events.
LVRS is used widely in Europe, though its application in the United States is mostly experimental.
A less invasive treatment is available as a bronchoscopic lung volume reduction Bronchoscopic lung volume reduction (BLVR) is a procedure to reduce the volume of air within the lungs. BLVR was initially developed in the early 2000s as a minimally invasive treatment for severe COPD that is primarily caused by emphysema. BLVR e ...
procedure.
Lung cancer surgery
Not all lung cancers are suitable for surgery. The stage
Stage or stages may refer to:
Acting
* Stage (theatre), a space for the performance of theatrical productions
* Theatre, a branch of the performing arts, often referred to as "the stage"
* ''The Stage'', a weekly British theatre newspaper
* Sta ...
, location and cell type are important limiting factors. In addition, people who are very ill with a poor performance status
In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients' general well-being and activities of daily life. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment ...
or who have inadequate pulmonary reserve would be unlikely to survive. Even with careful selection, the overall operative death rate is about 4.4%.
In non-small cell lung cancer staging, stages IA, IB, IIA, and IIB are suitable for surgical resection.
Pulmonary reserve is measured by spirometry. If there is no evidence of undue shortness of breath or diffuse parenchymal lung disease
Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs)) of the lungs. It concerns alveolar epithelium, pu ...
, and the FEV1 exceeds 2 litres or 80% of predicted, the person is fit for pneumonectomy
A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung.
There are two ...
. If the FEV1 exceeds 1.5 litres, the patient is fit for lobectomy.
There is weak evidence to indicate that participation in exercise programs before lung cancer surgery may reduce the risk of complications after surgery.
Complications
A prolonged air leak (PAL) can occur in 8–25% of people following lung cancer surgery. This complication delays chest tube removal and is associated with an increased length of hospital stay following a lung resection (lung cancer surgery). The use of surgical sealants may reduce the incidence of prolonged air leaks, however, this intervention alone has not been shown to results in a decreased length of hospital stay following lung cancer surgery.
There is no strong evidence to support using non-invasive positive pressure ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air i ...
following lung cancer surgery to reduce pulmonary complications.
Types
* Lobectomy
Lobectomy means ''surgical excision of a lobe''. This may refer to a lobe of the lung (also simply called a lobectomy), a lobe of the thyroid ( hemithyroidectomy), a lobe of the brain (as in anterior temporal lobectomy), or a lobe of the liver ...
(removal of a lobe of the lung)
* Sublobar resection (removal of part of lobe of the lung)
* Segmentectomy (removal of an anatomic division of a particular lobe of the lung)
* Pneumonectomy
A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung.
There are two ...
(removal of an entire lung)
* Wedge resection
Wedge resection is a surgical procedure to remove a triangle-shaped slice of tissue. It may be used to remove a tumor
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm ...
* Sleeve/bronchoplastic resection (removal of an associated tubular section of the associated main bronchial passage during lobectomy with subsequent reconstruction of the bronchial passage)
* VATS lobectomy
Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery.
Traditional approach to lung cancer surgery: thoracotomy
Anatomic lung resection, i.e. pulmonary lobectomy or pneumonectomy, in conjunction with rem ...
(minimally invasive approach to lobectomy that may allow for diminished pain, quicker return to full activity, and diminished hospital costs)
* esophagectomy
Esophagectomy or oesophagectomy is the surgical removal of all or parts of the esophagus.
Medical uses
The principal objective is to remove the esophagus, a part of the gastrointestinal tract. This procedure is usually done for patients with esoph ...
(removal of the esophagus)
See also
* '' Annals of Thoracic Surgery''
* ''European Journal of Cardio-Thoracic Surgery
The ''European Journal of Cardio-Thoracic Surgery'', abbreviated ''Eur J Cardiothorac Surg'', is an academic journal, principally covering topics pertaining to cardiac surgery and thoracic surgery.
Editorial board
The journal has an editorial bo ...
''
* ''Journal of Thoracic and Cardiovascular Surgery
''The Journal of Thoracic and Cardiovascular Surgery'' is a monthly peer-reviewed medical journal covering cardiothoracic surgery, cardiology, pulmonary medicine, and vascular disease published by Elsevier. It is the official journal of the Ame ...
''
References
External links
The Cardiothoracic Surgery Network
The Society of Thoracic Surgeons
American Association for Thoracic Surgery
International Society for Minimally Invasive Cardiothoracic Surgery
{{Thoracic surgery
Surgical specialties
Cardiac surgery
Thoracic surgery
Pulmonary thoracic surgery