Thoracic Surgery Unit

Istituto Clinico St Ambrogio

key figures 

CLINICAL SERVICES:

  • Lung Disease Diagnosis and Treatments
  1. Tumours
  2. Pleura and mediastinum/ bullous lung disease
  • Minimally invasive Thoracic Surgery 
  1. Lung resection 
  2. Pleurectomy 
  3. Lymphadenectomy  
  • Open Thoracotomy for pulmonary, pleural and mediastinal     procedures 
  • Lung Fine-needle aspiration biopsy (FNAB)

The most part of the Unit’s patients are suffering from malignant diseases. Following a histological diagnosis and staging, done in an outpatient setting, the surgical treatment is performed at the appropriate moment. After discharge, the patients are referred towards a medical oncologic treatment or towards rehabilitation. 

Considering existing comorbidities and the patient’s age, all the surgical treatments, for malignant or benign diseases, are personalised to each patient. 

For diagnosis and treatment, each case is discussed in a multidisciplinary board meeting involving all specialists related to this area of interest from various fields such as, Pneumology, Oncology, Radiotherapy, Anaesthesiology, and Physiotherapy in order to ensure an optimal approach in accordance with the most current guidelines, and with the use of state-of-the-art therapy protocols. 

In addition, the Unit performs treatment for bullous lung disease, frequently related to pneumothorax or to respiratory insufficiency in broncho-pneumo-pathic patients. 

 

treatments

Mininvasive Torascopic Surgery

This is a surgical method that is carried out by means of small access holes on the chest wall (from a minimum of two to a maximum of four) through which a camera is made to pass as well as a special long and thin instrument that allows the realization of interventions ranging from simple biopsies (pleural, pulmonary or lymph glandular) to more complex pulmonary resection. Access through these small holes reduces postoperative pain and days of hospitalization (3- 4), resulting in less aesthetic damage and allowing a shorter convalescence.

According to this method, in addition to pulmonary resections it is possible to perform operations on the pleura, removing more or less extensive parts, or acting on its surface with particular chemicals (such as talcum powder) to prevent the supply of fluid, pleural effusion (especially when the cause is represented by a tumour)

Main Pathologies Treated: 

  • Lung Cancer 

Top Procedures: 

  • Thoracoscopy
  • Pleural biopsies
  • Pulmonary biopsies
  • Mediastinal and / or supraclavicular lymph node biopsies
  • Chemical pleurodesis (talcage)
  • Pulmonary resections: parenchymal ablations for emphysema bosa or tumour nodule pathology
  • Thoracoscopy and treatment of PNX in urgency

Toracotomic Surgery

This is a surgery that involves opening the thorax (thoracotomy) and widening the ribs without damaging them, which allows to perform complex interventions such as large lung resections, removal of one or more lobes or an entire lung.

Main Pathologies Treated: 

  • Lung Cancer
  • Heart, Diaphragm Disorders 

Top Procedures: 

  • Resections
  • Lobectomy
  • Pneumonectomy
  • Empyemectomy
  • Decortications

Thoracic Wall Surgery

This surgery is performed for the correction of chest wall malformations, especially in young adolescent patients, and for cases where tumour diseases involve the breastbone or ribs.

Main Pathologies Treated:

  • Chest Wall Malformations
  • Tumour of the breastbone or ribs

Top Procedures:

  • Sternochondroplasty (for carinated and/or excavated chest)
  • Radical and reconstructive surgery

Neck and Mediasty Surgery

Neck or mediastinal surgery: this involves the removal of voluminous tumours, also benign (sometimes originating from the thyroid gland or thymus) that occupy the neck and the mediastinum (the space between the sternum and the lungs), compressing the trachea and bronchial tree, as well as the large vessels connected to the heart.

Main Pathologies Treated: 

  • Struma-Mediastinitis
  • Thymoma
  • Teratoma

Top Procedures: 

  • Surgical Procedures

Biopsy Procedures

Mediastinoscopy

Mediastinoscopy: these are biopsies of the mediastinal lymph glands (the space between the sternum and the two lungs) by means of a small incision at the anterior base of the neck (jugular).

Supraclaviar Biopsy

Supraclavicular biopsies: it involves removing the lymph glands (or small fragments of them) placed laterally at the base of the neck, just above the clavicles, to determine whether they are affected by diseases such as tumours of the lymphatic system or lung (or other organs). These interventions can often be performed under local anaesthesia.

Needle Biopsy

These procedures are carried out under local anaesthesia, which allows biopsies to be performed on the lung, inserting a thin needle into the thorax (to aspirate groups of cells) under the control of the CT scan; such procedures require hospitalization for 48-72 hours.

Bronchoscopy

It is a matter of introducing from the nose or the mouth, under local anaesthesia, a long thin and flexible instrument equipped with a camera to reach, visualizing the walls, the trachea and the bronchi, in order to determine whether biopsies are necessary.

SEE OTHER Thoracic Surgery Unit UNITS
- Thoracic Surgery (Ospedale San Raffaele)