Sunrise Hospital -Minimally Invasive Thoracic Surgery

Minimally Invasive Thoracic Surgery

Doctors
Treatment & Techniques

Minimally Invasive Thoracic Surgery

Department of Minimally Invasive Thoracic Surgery is headed by a renowned Cardiothoracic Surgeon Dr Nasser Yusuf. He qualified as Cardiothoracic Surgeon from KMC Manipal and was awarded the Gold Medal. Thereafter he secured a position in Ireland and subsequently in the UK, where he spent 8 years in this speciality. He is an adjuct faculty to Manipal University (University of Eminence)

He is the first to start Coronary Artery Bypass Surgery in Malabar at Fathima Hospital in 1998 and also has exposure to Heart Transplantation. In 1999, he pioneered Keyhole Surgery of Chest (Thoracoscopy) and Mediastinoscopy in Kerala for the treatment of Chest Dieseases. He has the unique distinction of having performed surgery on a 5 day old baby with pus surrounding the heart and also on a 105 year old man with a burst lung. To his credit, DR Yusuf has successfully removed one of the largest tumors ever reported in the world weighing 2.5 Kg (Size of a new born baby) from the Chest of a 50 year old lady.

In 2010, Dr Yusuf was invited to conduct the first ever successful live Thoracoscopy workshop in India at the National Conference in Jodhpur, Rajasthan. He Conducted the first Workshop on Keyhole Surgery of the Chest (VATCON) in Kerala in 2014. He was the Organising Chairman (Workshop) for the National Conference of Chest Physicians in 2019 as well as the Chairman for the All India Conference of Interventional Pulmonologists in 2021

Dr Yusuf has over 30 publications in inedxed journals and is a much sought after National and International Speaker. Patient referrals to Dr Yusuf come from both across India and Abroad on complicated and challenging thoracic issues.

Doctors

Dr. Nasser Yusuf

Consultant Cardiothoracic Surgeon

Treatment & Techniques

The Department uses minimally invasive surgical technique called Video-Assisted Thoracoscopic Surgery (VATS) for performing surgery in the chest area through small incisions. This avoids making large cuts or incisions in the body, and does not require spreading apart of the ribs as done with open surgeries. Surgeons use a camera and specialized instruments to get to the lung through small incisions in between the ribs for the surgery. VATS technique demands great deal of skill and it becomes that more important that the surgeon doing this procedure is experienced and renowned in this field.

Thoracic Procedures

Thoracic Procedures are speciﬁcally targeted towards Lung Cancer, Emphysema, Broncho Pleural Fistula, Bullectomies, Unilateral and Bilateral Bronchiectasis, Non Resolving Pneumonia, Decortication, Pleurectomy, Lung Biopsy in the treatment of Interstitial Lung Disease (ILD), Esophageal disorders and Chest Trauma. Other common procedures include palliative surgery for effusion from any cause - Liver Cirrhosis, Chylothorax, Breast, GI and Lung Malignancy, Curative Surgeries - (Hemoptysis, Cavity, Abscess, MDRTB, Aspergilloma). Excision of all types of Mediastinal Tumours and Surgery for Myasthenia Gravis.

Video-Assisted Thoracic Surgery (VATS) is frequently used by doctors to treat early stage of Lung Cancers. The surgery is done under general anesthesia with a breathing tube placed into the airway for lungs to be separately inflated during the surgery. During the surgical process, small incisions an inch wide between the ribs is made to see the entire chest cavity without having to open up the chest or spread the ribs. Small tube called a thoracoscope is inserted through these incisions between the ribs to remove the lung tissue with specialized instruments.

At the end of the surgery, a chest tube is retained through one of the small incisions to drain extra fluid or air leaking into the chest and help lungs to function normally. This tube remains in place for a few days and is typically removed at the bedside before you go home. Recovery time is relatively short compared to open surgery. Most patients regain their strength, energy and breathing in two to three weeks.

The advantages of Video-Assisted Thoracic Surgery (VATS) are faster recovery, fewer complications, shorter stay at hospital, less pain, decreased need of medication, less blood loss and no operational trauma with ribs.

Every patient who under goes this VATS surgery may have different surgical approach depending upon the a number of factors like health history and the type of lung cancer etc. Surgeons evaluate each patient for minimally invasive thoracic surgery on a case by case basis such as physical condition, medical history and anatomy. Talk to Dr Nasser Yusuf to know more about Video-Assisted Thoracoscopic Surgery (VATS) and if it is right for you.

Emphysema is a condition of lungs which results in shortness of breath due to damaged air sacs of lungs. The symptoms of emphysema are frequent coughing, cough that produces a lot of mucus, shortness of breath during physical activity, whistling sound while breathing and tightness in chest. Emphysema has four stages and diagnosing the diesease early can help relieve symptoms and slow the progression of the disease. Treatment options with medications include bronchodilator Medications, steroids and antibiotics. Vaccines and Oxygen and Protien therapy helps in the management of the breathing process. For some patients surgical options are Lung Transplantation and lung volume reduction surgery, during which small wedges of damaged lung tissue are removed. This procedure is done by Video-Assisted Thoracoscopic Surgery (VATS) technique.

A bronchopleural fistula is a serious condition caused by lung cancer surgery, pneumonectomy (removal of lung), chemotherapy, radiation, or an infection. Air that is breathed into the lungs leaks through the passageway and enter the membranes that line the lungs called pleural cavity resulting in bronchopleural Fistula. Bronchopleural Fistula is diagnosed by CT scan of the chest to reveal increased air or fluid or pus in the pleural cavity.

Treatment often involves in 3 steps. The first step is to drain the fluid that has accumulated in the pleural cavity due to the fistula. The second step is repairing the fistula through surgery, or endoscopically through a bronchoscopy tube which is safer and effective. And the third step is to get rid of pleural cavity so that fluid can no longer accumulate.

Bullectomies is a minimally invasive surgical process that removes bullae, an air space in the lung measuring more than 1 cm. Lungs is made up of collection of small air sacs, which helps in the transfer of oxygen into the blood stream. When these small air sacs in the lungs are damaged, they form to take up a large space called bulle, which doesnt have the capacity to absorb oxygen into the blood. Bullae are normally formed as a result from chronic obstructive pulmonary disease (COPD) commonly caused by smoking or long-term exposure to gas fumes. Most common symptoms of chronic obstructive pulmonary disease (COPD) are wheezing, tightness in the chest, frequent coughing up of mucus, lip or fingertip blueness, feeling tired and swelling of feet, leg, and ankle.

Preparation and Treatment:

A patient who under goes a host of physical tests to make sure that the patient is in good health for the procedure. This includes X-Ray, CT Scan and Angiography.

Bullectomy is performed with general anesthesia. During the Video-Assisted Thoracoscopy (VATS) small incisions an inch wide between the ribs is made to see the entire chest cavity without having to open up the chest or spread the ribs. Small tube called a thoracoscope is inserted through these incisions between the ribs to remove the bullae and other affected parts of your lung and the surgeon closes the cuts with sutures.

Unilateral and Bilateral Bronchiectasis is a long-term condition where the airways of the lungs become widened abnormally and damaged, resulting in the build-up of excess mucus and making lungs more vulnerable to infection. These infections can cause pneumonia, tuberculosis, immune system problems and cystic fibrosis. The most common symptoms of bronchiectasis is persistent cough with sputum, chest pain, shortness of breath, thinkening of skin under finger and toe nails and feeling tired. There is no cure for bronchiectasis, but early and effective treatment can help to reduce complications, prevent infections, control secretions, relieve obstructions in the airway and stop the disease from progressing.

Medications and physical therapy help to drain the mucus. In certain conditions, bronchiectasis affects only one lung or a limited area, or if damage is severe and there are frequent infections, surgery may be advised. A person with advanced bronchiectasis and cystic fibrosis lung transplantation is recommended though Video-Assisted Thoracoscopic Surgery (VATS).

Non resolving Pneumonia (NRP) is an acute pulmonary infection that does not improve or worsens after the treatment with antibiotic therapy for a minimum of 10 days or radiographic opacities fail to resolve within 12 weeks. Non Resolving Pneumonia is of two causes Infectious Causes and Non Infectious Causes. Tuberculosis and fungal infections are usually the cause of Infectious causes with non resolving pneumonia. Non Infectiouos causes includes neoplastic lesions, pulmonary oedema, pulmonary embolism, drug-induced pneumonitis, diffuse alveolar haemorrhage syndromes, cryptogenic organising pneumonia and acute eosinophilic pneumonia.

A patient with Non Resolving Pneumonia under goes physical tests X-Ray, CT Scan and CT Angiography.

With fiber-optic bronchoscopy (FOB) more than half of the cases of persistent pulmonary opacity is diagnosed. It allows direct visualization of affected area and the direct obtaining of samples for treatment procedures.

Video-Assisted Thoracoscopic Decortication is a surgical procedure that remove all the fibrinous peel and necrotic tissue in the lung, chest wall, and diaphragm. The goal of decortication is to allow the lung to expand and deflate and function normally. The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel which restricts lung expansion.

Pleurectomy is a minimally invasive surgery in which part of pleural lining around the lungs as well as other diseased tissues are removed. This procedure helps to prevent fluid from collecting in the affected area and is used for the treatment such as mesothelioma, a pleural mesothelial cancer, persistent or recurrent pleural fluid accumulation and malignant pleural fluid accumulation.

Pleurectomy is done under general anesthesia. During the procedure, an incision is made along the back and parallel to the lungs (thoracotomy). After gaining access to the chest, the surgeon then carefully peels away and removes the layers of pleura. After the surgery, drainage tubes are placed to drain extra fluid, till the bleeding and discharge are small. The incision is then closed, often with sutures that will dissolve on their own.

During the recovery period, respiratory therapy is administered to help patients to breathe deeply and get out of bed quickly to lower their risk of pneumonia, blood clots, and other complications. Pulmonary rehabilitation may be recommended down the line as well to improve breathing. Sometimes, pleurectomy greatly improve quality of life for people living with mesothelioma or a malignant pleural effusion.

Interstitial lung disease is caused by long-term exposure to asbestos, coal dust or rheumatoid arthritis. It is another term for pulmonary fibrosis, which is scarring and inflamation of tissues that surrounds the lung's air sacs, blood vessels and airways. This scarring and inflamation makes the lung tissue stiff, resulting in breathing difficulty. Symptoms of Interstitial Lung Disease include dry cough, shortness of breath, extreme tiredness and weakness, unexplained weight loss, mild pain in the chest and bleeding in the lungs. Video-assisted thoracoscopic (VATS) biopsy is considered as the gold standard for the treatment of interstitial lung disease (ILD). VATS lung biopsy can be performed under general anesthesia.

Video-assisted thoracoscopic surgery (VATS) has revolutionized the treatment of benign esophageal disorders such as asesophageal cancer, achalasia and gastroesophageal reflux disease (GERD). Advantages of Video-assisted thoracoscopic surgery (VATS) is shorter hospital stay, less postoperative discomfort, and much faster recovery time than with open surgery. Video-assisted thoracoscopy (VATS) is being used in many centers for the thoracic mobilization of the esophagus, reducing the size of the chest incision. In addition, laparoscopy can be used to mobilize the gastric conduit in the abdomen, reducing abdominal incision size as well.

Video-assisted thoracoscopic surgery (VATS) is widely used to treat patients chest trauma from simple rib fractures, heart and lungs. VATS can often provide greater visualisation of the intra-thoracic structures, whilst limiting the burden of injury to smaller non-rib spreading incisions. VATS is used as a diagnostic tool too, to identify the extend of the injuries whilst also allowing for treatment. This decreases the rate of post-operative complications and a shorter length of inpatient stay.

The benefits of VATS is decreased pain, pulmonary complications, prolonged air leak, arrhythmias, hospital stay, and post-operative quality of life are all improved by VATS surgery. The benefits of decreased pain, pulmonary complications, hospital stay and quality of life have been translated into the use of VATS in the trauma settings.

Other common procedures include palliative surgery for effusion from any cause - Liver Cirrhosis, Chylothorax, Breast, GI and Lung Malignancy, Curative Surgeries - (Hemoptysis, Cavity, Abscess, MDRTB, Aspergilloma). Excision of all types of Mediastinal Tumours and Surgery for Myasthenia Gravis.

Mediastinoscopy is used to diagnose lymph nodes and masses in the entire Mediastinum (Central portion of Chest) with 100% accuracy. Useful in Lymphoma, Sarcoidosis, Hypersensitivity Pneumonitis, esophagus cancer, tumor of the thymus gland and Staging of Lung Cancer. The procedure is done uder general anesthesia. A thin, flexible tube with a light, small video camera and cutting tool on the end is put through a small cut made behind the breastbone and between the lungs known as mediastinum. The procedure usually takes about 60 minutes, but it might take longer, depending upon the procedure.

Surgery for Empyema, Congenital Cystic Adenamatoid Malformation, Congenital Lobar Emphysema, Foreign body removal. etc are routinely performed.

Video assisted thoracoscopic surgery (VATS) technique is used more in pediatric thoracic procedures in children with childhood mediastinal tumors. Surgeons are able to explore and reach great vessels and other vital structures without major cuts or incisions. The safety and feasibility of this technique has been described for a wide range of procedures like pediatric empyema, Congenital Cystic Adenamatoid Malformation, Congenital Lobar Emphysema and Foreign body removal. Surgery is performed in an operating room and patients must be under general anesthesia. Video-assisted thoracoscopic surgery (VATS) helps to avoid the more invasive, traditional thoracotomy or sternotomy, diminishes the patient’s pain and trauma to the body, and significantly reduces the hospital stay.

Rigid as well as ﬁber-optic Bronchoscopy along with Rigid Oesophagoscopy, are also available. Facility for AFB Culture and Drug Sensitivity Testing especially in MDRTB and Frozen Section are available which ensures immediate diagnosis and appropriate treatment. The Department is supported by an expert team of Consultants in Surgery, Pulmonology, Cardiology, Anesthesia, Medicine, Physiotherapy, Respiratiory Therapy, Microbiology, Pathology and Psychology.

An active patient support group allays the fears and doubts in the minds of patients. Smooth running of the Department is ensured by the Patient Co-ordinator.

Thus we are able to provide services on par with the best centers in the world.

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Sunrise Hospital, Cochin (www.sunrisehospitalcochin.com)

A Unit of Sunrise Institute of Medical Sciences Pvt Ltd, Kerala, India.

GST No 32AAICS4341K2ZB

Minimally Invasive Thoracic Surgery

Minimally Invasive Thoracic Surgery

Minimally Invasive Thoracic Surgery

Doctors

Dr. Nasser Yusuf

Treatment & Techniques

Thoracic Procedures

Preparation and Treatment:

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Minimally Invasive Thoracic Surgery

Minimally Invasive Thoracic Surgery

Minimally Invasive Thoracic Surgery

Doctors

Dr. Nasser Yusuf

Treatment & Techniques

Treatment and Surgical Techniques

Video-Assisted Thoracoscopic Surgery (VATS)

Thoracic Procedures

Lung Cancer Surgery through Video-Assisted Thoracoscopic Surgery (VATS)

Emphysema through Video-Assisted Thoracoscopic Surgery (VATS)

Bronchopleural Fistula through Video-Assisted Thoracoscopic Surgery (VATS)

Bullectomies through Video-Assisted Thoracoscopic Surgery (VATS)

Preparation and Treatment:

Unilateral and Bilateral Bronchiectasis

Non resolving Pneumonia (NRP)

Decortication

Pleurectomy

Interstitial Lung Disease Biopsy

Esophageal disorders through Video-assisted thoracoscopic surgery (VATS)

Chest Trauma through Video-assisted thoracoscopic surgery (VATS)

Mediastinoscopy

Pediatric Thoracic Surgery (Children)

Airway Stenting in Tracheal and Bronchial Stenosis

Support Services

Links

Sunrise Videos

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