Patients Benefit from Minimally Invasive Thoracic Surgical Options

November 14, 2011

Thoracic diseases are those that occur in the organs, bony structures and tissues that form the chest cavity. They most commonly occur in the lungs and esophagus, the long, hollow tube that connects the throat to the stomach.

Michael Bousamra II, MD, is a board certified Cardiothoracic Surgeon who specializes in minimally invasive thoracic surgical treatments at Floyd Memorial. As Dr. Bousamra explained, “I’ve been in the thoracic surgery field for over 20 years, and in my short time working with Southern Indiana patients at Floyd Memorial, I’ve been very impressed with not only the technology available to me, but also with the teamwork I’ve witnessed among the caregivers. It’s evident that patient outcomes and comfort are the top priority, and I’m proud to be expanding my practice to this facility.”

Michael Bousamra “Developments in minimally invasive techniques have transformed the field of thoracic surgery in recent years. We’re able to perform procedures on major organs such as the lungs in a safer way with smaller incisions, fewer complications, less pain and faster recovery time.”

Michael Bousamra II, MD
Board Certified Cardiothoracic Surgeon
University Cardiothoracic Surgical Associates
Associate Professor of Surgery U of L School of Medicine

Working Together to Ensure the Best Possible Patient Outcomes

“The nature of what I do requires constant teamwork with a wide-range of specialists in order to ensure optimal patient outcomes,” said Dr. Bousamra. “From monthly tumor board meetings to collaboration with pulmonologists, gastroenterologists, radiation and medical oncologists on treatment plans for lung and esophageal cancer patients, to providing pathologists in the operating room for immediate diagnosis, Floyd Memorial does a fantastic job of ensuring thorough collaboration between physicians.”

A Remarkable Breakthrough in Lung Cancer Survival

Lung cancer is the leading cause of cancer deaths in the United States. One of the biggest reasons for that is the fact that it typically does not produce alarming signs or symptoms until it has reached an advanced stage and spread to other bodily tissues. Because of this, there has been a significant push towards early screening for at-risk populations. Dr. Bousamra explained that a recent multi-center study published in the New England Journal of Medicine showed an improvement in survival of patients who underwent annual screening with a chest CT scan. Patients older than 50 with a significant smoking history were included. Because of this finding, Floyd Memorial Hospital is now offering screening to appropriate candidates.

Minimally Invasive Lung Cancer Surgery Means Quicker Recovery & Less Pain

The standard surgical treatment for lung cancer, known as a lobectomy, involves removing the affected lobe of the lung along with its surrounding lymph nodes, in order to prevent further spread of the disease. While it once required a large incision on one side of the chest and separation of the ribs in order to gain access to the lungs, it can now be performed with a minimally invasive procedure known as Video-Assisted Thoracic Surgery (VATS).

Dr. Bousamra elaborated on how VATS works. “VATS allows me to access the diseased portion of the lung using only three to four small incisions. A long, thin tube with an attached camera known as a videoscope is inserted into one of the incisions. The scope allows visualization of the cancerous tissue, which is then dissected and removed using small, flexible instruments that are inserted into the remaining incisions. Pain is reduced significantly and hospital recovery time is decreased usually to only three to four days compared to six to seven days with the traditional open procedure.”

Lobectomy
Lobectomy removes the entire draining path for cancerous tumor cells. The right lung has three lobes, while the left lung has two lobes. A lobectomy removes the entire cancerous lobe by dividing the airway, arterial blood supply and vein associated with that lobe. Local lymph nodes are also removed to reduce the chance of recurrence.
Video-Assisted Thoracic Surgery
Video-Assisted Thoracic Surgery (VATS) allows access to the lung via three to four small incisions into which a videoscope camera and small, flexible instruments are inserted.
Open Thoracic Surgery
Open Thoracic Surgery (also known as a Thoracotomy) requires a large incision on one side of the chest, that is then opened with retractors to spread the ribs and allow access to the lung.

Aggresive Treatment for Esophageal Cancer

“While esophageal cancer remains relatively rare, we’ve seen a dramatic increase in one subtype, Adenocarinoma, in the American population over the last 15 years,” said Dr. Bousamra. “The cause of this increase is still unknown, but many researchers have suggested that it may be related to higher rates of gastroesophageal reflux disease (GERD), obesity and changes in the American diet. As a surgeon, it’s something that I prefer to treat very aggressively. I work with the patient’s medical and radiation oncologists to coordinate chemotherapy and radiation therapy before surgery in most cases. This approach has improved survival for qualified patients. Some patients are unable to undergo such an aggressive three-part regimen, and may be treated by either chemotherapy and radiation therapy or surgery alone.”

“The surgical procedure involves two incisions, one in the abdomen and one in the chest. The cancerous portions of the esophagus, stomach and any surrounding lymph nodes are removed to prevent further spread of the disease and improve the chance of long-term survival. The stomach is then sewn to the remainder of the esophagus high in the chest cavity. This is done to reduce the risk of gastric reflux, since surrounding pressure is lower in the chest than in the abdomen. Esophagectomy is a major procedure and recovery can be slow, but with attention to detail and excellent hospital care results are gratifying.”

Esophagus Cancer Removal Surgery

Esophagectomy Offers Hope for Esophageal Cancer Recovery

Providing Access to Cutting Edge Research & Clinical Trials

As an associate professor at the University of Louisville School of Medicine, Dr. Bousamra has opened the doors for cutting edge cancer research and clinical trails to Southern Indiana patients, including a currently enrolling study on tumor metabolism in lung cancer patients. Although he has an office located on Cottom Avenue in New Albany just across from Floyd Memorial Hospital, his position with the University of Louisville allows patients to benefit from large research studies while maintaining their close-to-home physician visits and hospital access.

What Conditions do Thoracic Surgeons Treat?

Thoracic surgeons treat diseases of the organs, bony structures and tissues that form the chest cavity, including:

  • Lung cancer
  • Esophageal cancer
  • Lung infections
  • Severe emphysema
  • Tumors of the chest cavity (Thymomas)
  • Hiatal hernia
  • Gastroesophageal reflux disease (GERD)
  • Swallowing disorders such as Achalasia

Lung Cancer Signs & Symptoms

Early lung cancer typically does not cause signs or symptoms. If you experience any of these conditions, consult with your primary care physician immediately.

  • Coughing up blood
  • A new cough that doesn’t go away
  • Changes in a chronic or “smoker’s cough”
  • Shortness of breath
  • Wheezing
  • Chest pain
  • Hoarseness
  • Unexplained weight loss
  • Bone pain
  • Headache

Esophageal Cancer Signs & Symptoms

Early esophageal cancer typically does not cause signs or symptoms. If you experience any of these conditions, consult with your primary care physician immediately.

  • Difficulty swallowing
  • Unexplained weight loss
  • Chest and upper abdominal pain, pressure or burning
  • Frequent choking while eating
  • Indigestion or heart burn
  • Persistent cough
  • Hoarseness
  • Fatigue