Thoracic surgery

Thoracic surgery involves the diagnosis and surgical treatment of diseases and trauma of the chest and its organs, with the exception of the heart, aorta and oesophagus. Close collaboration with other specialists such as pulmonologists, cardiologists and oncologists is a characteristic feature of modern thoracic surgery.

Our national and international networking with the best centres worldwide guarantees high-quality treatment in line with the most up-to-date standards. Lung transplants are performed exclusively at the University Hospitals of Zurich and Lausanne.

Thoracic surgical procedures

Thoracic surgeons assess, in particular, diseases or injuries of the lungs, trachea and bronchi, the thorax (ribs and sternum), the organs of the mediastinal cavity (thymus, lymph nodes) and the diaphragm (paralyses, hernias) and perform surgical treatment.

Principally, this involves cancers such as:

  • Lung cancer
  • Lung cancer screening 
  • Lung metastases
  • Tumours of the thymus
  • Tumours of the pleura, such as mesothelioma and pleural fibromas
  • Other

Diseases not related to tumours

  • Advanced emphysema: in this procedure, the lung, which is over inflated and thus primarily responsible for breathlessness, is restored to its standard size using a minimally invasive procedure
  • Thymus removal in myasthenia gravis 
  • Spontaneous pneumothorax (collapsed lung) in patients with or without lung disease
  • Pleural effusion, inflammatory as well as malignant
  • Pleural empyema (purulent effusion in the pleural space)
  • Bronchiectasis and lung abscess
  • Excessive sweating of the hands (hyperhidrosis/sympathectomy)
  • Chest wall deformities such as thoracic hyperkyphosis (hunchback), pectus excavatum (funnel chest) and pectus carinatum (pigeon chest)
  • Lymph node changes if needle biopsies prove inconclusive
  • Other

Surgical procedures

The spectrum of surgical procedures employed is extremely broad and must be tailored to match, among other factors, the size and aggressiveness of a tumour and the patient’s lung reserves and overall condition. Smaller lung tumours are treated by simple wedge resection or segmental resection.

Larger tumours require removal of the lobe of the lung (lobectomy) or, in rare cases, removal of an entire side of the lung (pneumonectomy). In cancer patients, the lymph nodes in the surrounding area must also be removed.

These procedures may involve simultaneous reconstruction of the chest wall or resection and anastomosis (reconnecting suturing) of bronchi and/or arteries.

Lung metastases are removed from the lung either by means of a laser or by wedge resection. 

A wide range of surgical procedures not requiring removal of lung tissue also exist. The thymus as well as tumours in the mediastinum (the space between the heart and the breastbone) can be completely removed. In patients with excessive sweating of the hands, the surgeon targets and cuts specific nerve fibres; in patients with diaphragm paralysis, the space for the lungs is re-extended by tightening and lowering the diaphragm using surgical suturing.

Techniques employed

Most surgical procedures involving the lungs and other thoracic procedures can now be performed using minimally invasive keyhole techniques. These involve either video-assisted thoracic surgery (VATS) or Da Vinci robot-assisted thoracic surgery (RATS) to precisely guide instruments. In both techniques, the camera and instruments are inserted into the thorax between the ribs through 5–10 mm thick tubes (trocars). The video cameras employed are of an extremely high quality and, with the right expertise, allow the surgeon to perform precise surgery. The scars left are barely noticeable and post-operative pain is minimal.

Occasionally, such as to remove very large tumours or for very high-risk operations, a larger incision is needed along the ribs (thoracotomy) or through the sternum (sternotomy). Even patients that require such large surgical approaches generally recover very quickly.

Interdisciplinary co-operation

To provide optimal treatment, modern thoracic surgery requires close co-operation with other disciplines.

  • Pneumology (preoperative examinations, lung function testing and collaborative care)
  • Anaesthesia (narcosis and collaborative care in the monitoring ward)
  • Oncology
  • Radio-oncology (radiation treatment strategies before, after or instead of surgery)
  • Radiology (precise imaging for diagnostics and planning of surgery, long-term follow-up)
  • Cardiology (e.g. assessment of risk prior to surgery)
  • Physiotherapy