10 โรคทรวงอก ที่รักษาได้ด้วยการผ่าตัดส่องกล้องแผลเล็ก

In an era where PM 2.5 dust is found in every region of Thailand, along with the ongoing COVID-19 pandemic, thoracic diseases have become one of the increasingly common problems. According to statistics from the Thoracic Surgeons Association of Thailand in 2020, there were more than 5,000 patients nationwide who received treatment through ‘thoracic surgery’. The organs in the thoracic cavity include the heart, lungs, esophagus, bronchi, as well as many important blood vessels.
Treating or performing surgery for thoracic diseases is similar to treating other diseases, starting with identifying the cause, severity, and location of the disease to ensure accurate and appropriate treatment. Doctors will evaluate and plan the treatment accordingly, with patients giving their consent to the treatment plan with a clear understanding of the shared goals.
Dr. Sira Laothai specialist thoracic and pulmonary surgeon, expert in thoracoscopic surgery at Phyathai 1 Hospital, stated: 
“The standard method for thoracic organ surgery remains open surgery, which involves using instruments to spread the ribs around the 5th rib. The surgical incision is approximately 15-20 centimeters long. The advantage is that the surgeon can clearly see the area to be operated on and perform the surgery easily because the ribs can be moved left or right to view different angles more than thoracoscopic surgery. The disadvantages include potential pain for the patient, rib fractures, irritation of nerves in the area, large scars, higher risk of blood loss, postoperative pain, and a longer recovery period.”
<h2>Single-incision thoracoscopic surgery (VATS): A better new option 
</h2>
With advancing technology and more skilled surgeons, surgical methods have also greatly improved. The treatment approach for lung and thoracic diseases has shifted from large open incisions to single-incision thoracoscopic surgery (Uniportal video-assisted thoracoscopic surgery; VATS). This technique uses a long lens along with specialized surgical instruments inserted through the 4th or 5th intercostal space without the need for rib spreading devices. Patients only have a small incision of about 3-4 centimeters, resulting in less pain after surgery, faster recovery, and quicker return to normal daily activities. The treatment outcomes are equally effective compared to open surgery.
<h2>10 thoracic diseases suitable for small-incision thoracoscopic surgery 
</h2>
The 10 thoracic diseases that can be treated with small-incision thoracoscopic surgery include:
<ol>
<li>Lung cancer</li>
<li>Benign lung nodule</li>
<li>Spontaneous or catamenial pneumothorax</li>
<li>Myasthenia gravis</li>
<li>Thymoma</li>
<li>Empyema thoracic</li>
<li>Malignant pericardial effusion, malignant pleural effusion</li>
<li>Palmar hyperhidrosis</li>
<li>Pectus excavatum</li>
<li>Pericardial cyst, bronchogenic cyst, esophageal cyst</li>
</ol>
<h2>However, patients must prepare for thoracoscopic surgery by: 
</h2>
<ol>
<li>Stopping certain medications before surgery, such as aspirin or blood thinners</li>
<li>Quitting smoking at least 4 weeks before surgery if the patient smokes</li>
<li>Exercising regularly before surgery</li>
<li>Practicing breathing exercises using a device called a spirometer</li>
<li>Avoiding eating or drinking after midnight before surgery</li>
<li>Some patients may require additional special tests at the doctor’s discretion, such as chest X-rays to examine the heart and lungs, CT scans of the heart and lungs, and PET/CT scans to detect cancerous tissues</li>
</ol>
Ultimately, the decision to use thoracoscopic surgery (VATS) depends on the doctor’s judgment and the thoracic surgeon’s expertise in thoracoscopic techniques. Limitations of thoracoscopic surgery include not using it for complex reoperations such as vascular reconstruction or for tumors larger than 7 centimeters.
&nbsp;
Assoc. Prof. Dr. Sira Laothai 
Specialist in pulmonary and thoracic diseases 
Internal Medicine Center, Phyathai 1 Hospital

The new approach to lung and thoracic surgery uses single-incision thoracoscopic surgery. Patients will have only a small incision of about 3-4 centimeters. After surgery, there is less pain, faster recovery, and the treatment results are as good as those of open surgery.

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10 Chest Diseases Treatable with Minimally Invasive Thoracoscopic Surgery

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