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Thoracic Surgery at North Shore-LIJ

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Treatments We Offer

Thoracic Surgery Treatments

General thoracic surgery treats conditions such as lung diseases, tumors, cancers, as well as transplants, esophageal problems and gastroesophageal reflux.

North Shore-LIJ thoracic surgeons receive advanced training and certifications. The majority of their procedures are conducted using minimally invasive techniques, including robotic surgery and video-assisted thoracoscopic surgery (VATS). Like robotic surgery, VATS uses advanced video technology that is inserted through small incisions and allows the surgeon to see the interior of the chest without the need for a large incision. This technique can have significant benefits to the patient, including quicker recovery, reduced risk for infection, and less scarring. For more information on minimally invasive and robotic surgery, click here.

Achalasia Mediastinal Disease (Mediastinal Tumors) 
Airway Conditions Mesothelioma
Alveolitis Myasthenia Gravis
Bronchiectasis Pneumonia
Bronchiolitis Pneumothorax
Bronchitis (Acute) Pulmonary Hypertension
Bronchitis (Chronic) Pulmonary Embolism
Byssinosis Pulmonary Fibrosis
Cancer of the chest wall / Chest Tumors Sarcoidosis
Esophageal Cancer Severe Acute Respiratory Syndrome (SARS)
Hyperhidrosis / Sweaty Palm Syndrome Thoracic Aortic Aneurysms
Lung Cancer  
Lung Nodules  

Call us at 1 (855) 432-7811 to reach our thoracic surgery team.


Treatments for Achalasia
The goal of all treatments of achalasia is to relieve the narrowing of the esophagus due to increased pressure at the lower end of it.
Often, the first treatment will be administered by a gastroenterologist, who may try to perform balloon dilatation or injection of Botox® into the area. These treatments may be of help but are often only temporary.
Robotic surgical treatment such as the modified Heller myotomy is often used successfully for this disorder to open up the muscle fibers. The risks of regurgitation and aspiration pneumonia are decreased after myotomy, and many people can resume a normal diet after undergoing the procedure.

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Treatments for Airway Conditions (Asthma, Occupational Asthma, Bronchitis, Emphysema, Chronic Obstructive Pulmonary Disease (COPD)
Treatments for airway conditions can encompass a variety of tactics from quitting smoking, taking medications to decrease inflammation, regular oxygen supplementation and pulmonary rehabilitation.

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Treatments for Alveolitis
Treatment plans are personalized to the needs of the patient, but can include medication, changing lifestyle habits, oxygen therapy or surgery to repair the affected area.

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Treatments for Bronchiectasis
Antibiotics and chest physical therapy are often used to treat bronchiectasis. The main objective is to control infections and bronchial secretions, relieving airway obstruction and preventing complications. Regular, daily drainage to remove bronchial secretions is a routine part of treatment, and a respiratory therapist can show the patient exercises to aid in this.

Antibiotics, bronchodilators and expectorants are often prescribed for infections by a pulmonary medical specialist. If medicine does not work or if the patient has massive bleeding, surgery to resect the lung may be needed. These operations may be done through a minimally invasive or more standard approach, depending on the amount of scar tissue present in the chest.

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Treatments for Bronchiolitis
Bronchiolitis treatments include:

  • Chest Physical Therapy (CPT), or chest clapping -- pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so you can cough it up.
  • Drinking enough fluids.
  • Breathing moist (wet) air -- helps loosen the sticky mucus. You can use a humidifier to moisten the air (follow the directions on the humidifier).
  • Getting plenty of rest.
  • No smoking.

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Treatment for Bronchitis (Acute)
This can be treated with at home remedies from having plenty of fluids, using over-the-counter cough medication, and getting plenty of rest.

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Treatment for Bronchitis (Chronic)
It is important to stay away from anything that can aggravate and lower the air quality and to avoid smoking. There are certain medications that can be inhaled into the lungs to help patients.

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Treatments for Byssinosis
To be treated for byssinosis, you must end exposure to the dust that caused your disease. You may even need to change jobs to accomplish this.

Additional treatments for byssinosis include medications such as bronchodilators to improve your symptoms, home oxygen therapy (if your blood oxygen levels are low), smoking cessation, physical exercise programs, breathing exercises and patient education. 

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Treatments for Cancer of the chest wall/ Chest Tumors
In the case of malignant chest wall tumors, treatment options are similar to those for other forms of cancer. Radiation therapy, chemotherapy or surgical removal might be recommended.
In many cases for both benign (non-cancerous) and malignant (cancerous) tumors, a removal of the affected chest wall with reconstruction is possible, and placement of a graft of a foreign material such as gortex or plastic mesh is often utilized.

In special cases, we work in conjunction with colleagues who specialize in plastic surgery to provide soft tissue coverage of the chest wall graft. This results in excellent long-term results and a cosmetic closure of a complicated surgical field.

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Treatment for Emphysema
Most patients with emphysema are treated medically but some may be helped by an operation called Lung Volume Reduction Surgery (LVRS). Recent innovations in surgical techniques and thoracic anesthesia have made this operation -- originally developed in the 1940s -- a safe and feasible option for emphysema.

Our system was of the centers across the country who participated in a landmark randomized multi-site trial that compared surgery to medical treatment in emphysema. This surgery has been shown to help some emphysema patients breathe better, with documented pulmonary function improvements, improved functional testing and longer life in properly selected patients. This operation, which can be done in a minimally invasive fashion, can be of significant help to patients who are otherwise disabled from emphysema.

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Treatment for Empyema
Surgical treatment of empyema is often crucial in allowing the infection to resolve. We work with our infectious disease colleagues to select proper intravenous antibiotics tailored to attack the individual infection.

Surgical treatment may include bedside drainage with a tube to remove the infected fluid, but often the infection will require an operation. Many times a minimally invasive approach, using our high definition video technology and special VATS (video assisted thoracic surgery) instrumentation will be successful in removing the infected material and expanding the lung to its full potential.

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Treatments for Esophageal Cancer
Treatment for esophageal cancer is very individualized and is based on the type and stage of the cancer at the time of diagnosis, as well as the overall condition of the patient. Early tumors are often removed as the primary treatment. The surgery is complicated, and the risks, benefits and alternatives are discussed in detail with the patient and family.

If the cancer has not spread to other organs, surgery may be performed to remove a portion of the esophagus. In some cases, this will also involve removing a part of the stomach and transfer of the remaining stomach to act as a new conduit for food passage.  Some parts of the procedure may be done via a minimally invasive esophagectomy (MIE). 

More advanced tumors may be helped by combined therapy. Chemotherapy and radiotherapy treatments may be utilized before and/or after the surgery. This depends on the specific situation and stage of the tumor. If the cancer has spread to other organs, this combined therapy is the most common treatment. Some people need help to swallow, and in certain situations, a stent may be placed in the esophagus to aid in improved swallowing and nutrition.

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Treatments for Hiatal Hernia
Hiatal hernia is most often treated with oral medications. A gastroenterologist will likely prescribe medicine to diminish the amount of acid produced in the stomach. If this does not relieve symptoms, surgical therapy may be needed.

Surgery for this condition is designed to reduce the protruding part of the stomach back into the abdomen. This may be done through a minimally invasive laparoscopic or robotic procedure. Sometimes an approach between the ribs directly into the chest cavity is used, particularly in complicated cases or repeat operations.

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Treatments for Hyperhidrosis / Sweaty Palm Syndrome
Our team is one of the leaders in minimally invasive approaches to hyperhidrosis (sweaty palm syndrome).The operation, which takes about an hour, is done with two tiny incisions in the armpits and is an outpatient procedure in almost all cases. 
Some people will have a new pattern of sweating on the lower half of the body (compensatory sweating), which is most often well tolerated and an acceptable lifestyle trade off. Return to normal work and exercise is very quick after the surgery.

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Treatments for Lung Cancer
The role of the thoracic surgeon in the treatment of lung cancer is varied but very important. Both diagnostic and treatment plans may be recommended by our surgeons.

Our center regularly uses a multidisciplinary approach, with a whole team of specialists involved in the decision-making process. This may include pulmonary medical doctors, medical oncologists, radiation oncologists and others. From a surgical standpoint, we offer a full range of diagnostic and treatment options in lung cancer.

We often can remove these tumors with a minimally invasive, video assisted thoracic surgery (VATS) approach. Across the nation, only about 25 percent of tumors are removed this way; our surgeons are able to perform minimally invasive approaches in approximately 75-80 percent of lung cancer cases -- one of the highest rates in the nation. This not only allows for a more rapid recovery, but there is mounting scientific evidence that these techniques offer a better long-term outcome for lung cancer patients. This approach often is helpful to lung cancer patients with emphysema or COPD, for whom a more traditional surgery would not be as well tolerated.

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Treatments for Lung Nodules
Benign pulmonary lung nodules require no treatment. Cancerous lung nodules, however, usually are surgically removed. The procedures used depend on the size, condition and location of the nodule.

Observation with repeat CAT scans in three to six months may be recommended. If this is the case, the patient will be given a prescription with a date for a repeat comparison study, and then will be required to return to review both the older and more recent scans. This will determine if the nodule has changed in size or shape. Sometimes removal of a nodule because of suspicion of cancer is necessary.

In many cases, a minimally invasive approach to remove the nodules can be used, which means the spot can often be removed with only a limited amount of lung tissue. Hospital stay is quite brief in many cases, and for most patients, surgery and removal of the nodule is the only treatment necessary.

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Treatments for Lymphadenopathy (enlarged lymph glands in the chest)
Treatments for enlarged nodes are dependent on the patient's underlying condition. Thoracic surgeons have many different options in the diagnostic evaluation of the enlarged mediastinal nodes. Bronchoscopy with trans-bronchial biopsy of the nodes is one option. This may or may not be suitable, and surgical biopsy through the neck with a small incision at the upper portion of the breast bone, called mediastinoscopy, may be able to access the nodes and get a bigger piece of tissue for examination.

Video-assisted thoracic surgery (VATS) with a camera inserted between the ribs may also be used to remove or sample an enlarged lymph node in the chest.

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Treatments for Mediastinal Disease (Mediastinal Tumors)
Depending on the size, position and clinical scenario, removal or biopsy of mediastinal tumors may be recommended. In many cases, removal of the mass is the only therapy needed. 
This may be done with small incisions and a robot or video camera, or with larger incisions, depending on the size and position of the tumor. In some cases, a biopsy alone to obtain a piece of tissue for diagnosis will be recommended as a first step. Some benign-appearing masses, such as cysts, may be observed over time and left alone unless they enlarge.

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Treatments for Mesothelioma
Treatment of mesothelioma, like many other tumors in the chest, depends on the stage and extent of disease. Our protocols are designed to provide the best long-term outcome and the best preservation of lung tissue and patient function. We work with our interdisciplinary tumor board to come up with an individualized plan for each person. This may include surgery, chemotherapy and radiation treatment.

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Treatments for Myasthenia Gravis
Both medical and surgical treatment may be helpful to myasthenia gravis patients. Medicines that suppress the immune system and intravenous treatments can be of benefit.

Surgery may offer a permanent cure or significant improvement in many patients. Removal of the thymus gland, which is in the lower neck and upper chest, has been known for many years to improve patients with myasthenia. In some patients a complete remission may be obtained.

We offer all surgical approaches in MG, many of which are minimally invasive and can lead to a rapid hospital discharge and quick recovery from surgery. This includes video thoracoscopic, trans-cervical, robotic and other surgical methods. Myasthenia patients may also have tumors of the thymus gland, thymoma. These are removed along with the rest of the thymus gland, and depending on the pathology, may require no further therapy.

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Treatments for Pleural Effusion
Surgical treatment of pleural effusion may include chest tube drainage or surgery to drain and examine the chest cavity. The treatment is often done with a video camera and small incisions between the ribs. Options for treatment of the effusion are multiple and are chosen based upon the patient’s condition.

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Treatments for Pneumonia (Bacterial pneumonia, Bronchial pneumonia, Chronic eosinophilic pneumonia, Lobar pneumonia, Mycoplasma pneumonia, Viral pneumonia
There are different treatment options for each of these specific conditions. There are several antibiotic medications and vaccines available as treatments for preventing pneumonia.

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Treatments for Pneumothorax
It is possible for a pneumothorax to repair itself. However, initial treatment of pneumothorax usually includes drainage of the air, if it is felt to be substantial. This is performed with a chest tube or drain place in between the ribs and into the chest cavity.  

The lung may require a surgical procedure to repair the leak site, and this is often done with a video assisted thoracic surgical (VATS) approach in which the area is removed with an endoscopic stapler. Hospitalization is usually several days following surgical repair if that course of treatment is chosen.

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Treatments for Pulmonary Hypertension (primary and secondary)
Treatments are determined depending on the source of the hypertension and if it is primary or secondary.  For patients with primary pulmonary hypertension (those with no underlying cause), more advanced treatments for pulmonary hypertension may be attempted, such as a combination of medication and/or surgery. If a clot is present, surgery can be used to remove it.

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Treatments for Pulmonary Embolism
Medical therapy plays a key role in the treatment of pulmonary embolism. Blood thinners, and on occasion, clot dissolving medications, may be initiated. 

For the last 10 years our surgical group has employed an aggressive approach to the sickest patients with pulmonary embolisms. In the patients with a large clot, the obstruction in the circulation may produce shock or sudden death. Many of these urgent or emergent patients have been operated upon with removal of the clots allowing a return to long-term normal function.

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Treatments for Pulmonary Fibrosis
Pulmonary fibrosis patients are treated with medicines, oxygen therapy and pulmonary rehabilitation. The goal of treatments for pulmonary fibrosis is to prevent more lung scarring.

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Treatments for Sarcoidosis
Sarcoidosis usually goes away on its own, but in the event that treatments are needed, therapy is administered with the goal of making sure the lungs and all other affected organs are working without strain or interference. There are certain medications that can be taken to limit symptoms, but they are usually avoided in the initial steps.

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Treatments for Severe Acute Respiratory Syndrome (SARS)
Patients with severe acute respiratory syndrome (SARS) often require oxygen. Serious cases require treatments like mechanical ventilation. No medication has been proven to treat SARS effectively.

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Treatments for Thoracic Aortic Aneurysms
When a patient suffers a thoracic aortic aneurysm, surgery is possible to repair the aortic valves (they may need to be replaced or repaired). Treatments for thoracic aortic aneurysms include minimally invasive techniques and approaches to minimize the trauma to the area.

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Treatments for Tracheal Stenosis
Options for tracheal stenosis include surgery and removal of the affected zone or stent implantation depending on the background and extent of the narrowing. Our surgeons work regularly to fix these complicated disorders, often working in tandem with other specialists to help improve the difficult breathing that results.

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Treatments for Tuberculosis (TB)
Most tuberculosis cases can be treated medically, but some cases are resistant to antibiotics, so surgical removal of the involved area may be required. Our surgeons have decades of expertise in this complicated and difficult surgery.

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