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Thoracic Surgery at AGH

Allegheny General Hospital has a long history as a nationally renowned heart care program for its superior, state-of-the-art facilities, treatments and research. Our surgeons, cardiologists and electrophysiologists have pioneered groundbreaking approaches to treat a variety of thoracic conditions and are among the most highly skilled in the country. Our cardiac nurses have the right mix of technical expertise and compassion to care for even the most complex cases, and our researchers and physicians look for promising new ways to treat thoracic disease for the best possible outcome for you.

We understand that every heart patient has different needs, circumstances and challenges and that no one treatment plan is suited for every patient. That is why we have teams of professionals who share their areas of expertise with each other to develop an in-depth medical strategy specific to each patient’s condition and situation. While receiving any care from us, this dedicated team works diligently to provide you with comfortable, reassuring care that is focused on you.

Treatment for thoracic disease depends on each patient’s condition and situation. Our multidisciplinary team collaborates to develop an optimal treatment plan that is specific to your case, needs and circumstances.

We use advanced procedures and techniques to treat the following thoracic diseases: 

Esophageal cancer and disorders

At the Allegheny Health Network Cancer Institute, we have a multidisciplinary team of surgical, radiation and medical oncologists who collaborate to develop an optimal treatment plan for you and your specific cancer. This spectrum of care ensures that you have access to every possible treatment, procedure and clinical trial best suited for your situation.

If you have esophageal cancer, your doctor will discuss a treatment plan with that is based on a number of factors, including your overall health, stage of the cancer and your personal preferences. Typically, options include a combination of treatments, including surgery, radiation therapy, chemotherapy or targeted drug therapy.

Our surgeons are leaders in performing this surgical procedure for esophageal cancer and other esophagus-related disorders, including benign tumors and strictures:

Esophagectomy is a surgical procedure to either remove the cancer or to relieve your symptoms. It involves a surgeon making an incision in your chest and removing all or part of your esophagus. The surgeon then reconstructs your esophagus using another part of your body, typically your stomach or intestine.

When appropriate, some esophagectomies are performed with a minimally invasive approach known as video-assisted thorascopic surgery (VATS). This involves surgeons operating through a few small incisions and using sleep instruments and 3-D, high-definition cameras and visions systems.

Lung cancer and conditions

At the Allegheny Health Network Cancer Institute, we have a multidisciplinary team of surgical, radiation and medical oncologists who collaborate to develop an optimal treatment plan for you and your specific cancer. This spectrum of care ensures that you have access to every possible treatment, procedure and clinical trial best suited for your situation.

If you have lung cancer, your doctor will discuss a treatment plan with that is based on a number of factors, including your overall health, stage of the cancer and your personal preferences. Typically, options include a combination of treatments, including surgery, radiation therapy, chemotherapy or targeted drug therapy.

Our surgeons are leaders in performing these surgical procedural – minimally invasively when appropriate – for lung cancer and other lung-related disorders:

Wedge resection is when surgeons remove a small section of your lung that contains the tumor, along with some of the surrounding healthy tissue.

Segmental resection involves removing a large portion of your lung but not the entire lobe.

Lobectomy is when a surgeon removes the entire lobe of one of your lungs.

Pneumonectomy involves the removal of your entire lung.

Chest wall and sternum tumors

At the Allegheny Health Network Cancer Institute, we have a multidisciplinary team of surgical, radiation and medical oncologists who collaborate to develop an optimal treatment plan for you and your specific cancer. This spectrum of care ensures that you have access to every possible treatment, procedure and clinical trial best suited for your situation.

If you have chest wall or sternum tumors, your doctor will discuss a treatment plan with that is based on a number of factors, including your overall health, stage of the cancer (if cancerous) and your personal preferences. Our surgeons are leaders in performing this surgical procedural – minimally invasively when appropriate – for chest wall and sternum tumors:

Chest wall resection involves removing a portion of your chest wall or sternum where the tumor is located.

Esophageal motility disorders

Esophageal motility disorders include a range of diseases, such as achalasia, are diseases of your upper digestive tract that affect your esophagus’ ability to contract and work properly. Typically, when you swallow, the coordinated muscular contractions of your esophagus push food from your throat to your stomach.

 

If you have an esophageal motility disorder, your esophagus’ muscle contracts are weak or uncoordinated, interfering with food movement. The main symptom you will experience is persistent difficulty swallowing solids and liquids and sometimes regurgitation of food.

Achalasia, and other esophageal motility disorders, symptoms can usually be managed with minimally invasive therapy or surgery, including:

Laparoscopic Heller myotomy is a minimally invasive procedure that opens the tight lower esophageal sphincter (the valve between your esophagus and stomach). Surgeons cut the thick muscle of the lower part of your esophagus and the upper part of your stomach to relieve the difficulty you have swallowing. Then your stomach is partially wrapped around your esophagus to make a low-pressure valve to prevent reflux from entering your esophagus from your stomach.

POEM (peroral endoscopic myotomy) is when a surgeon accesses your esophagus through your mouth with an endoscope (a long thin tube). Then instruments are fed through the endoscope to perform the myotomy (cutting the lower part of your esophagus and upper part of your stomach to relieve the obstruction). This is all done without making any incisions in your skin, which speeds up the healing process, limits or eliminates pain and leaves you with no scar. Allegheny Health Network is the first site in western Pennsylvania to offer this minimally invasive surgical treatment.

Gastroesophageal reflux disease (GERD) and hiatal hernia

Gastroesophageal reflux disease (GERD) is a disorder where your stomach acid and enzymes back up into your esophagus and injure its lining. Over time, this damage (dysplasia) can transform esophageal tissue into intestinal tissue and lead to Barrett’s esophagus or cancer. Because Barrrett's esophagus is a disease without symptoms, regular upper endoscopies and biopsies are required to determine if the disease has progressed or if cancer is present.

A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest. A hiatal hernia results in retention of acid and other contents, since the stomach tends to get squeezed by this opening in the diaphragm. These acids, and other substances, can easily backup (reflux or regurgitate) into your esophagus.

Allegheny Health Network surgeons are considered leading specialists in the country and pioneers in the field of minimally invasive surgeries and endoscopic therapies for treating Barrett’s esophagus, GERD and hiatal hernia. Our procedures include:

Laparoscopic Nissen fundoplication strengthens the valve between your esophagus and stomach by wrapping the upper curve of the stomach around the esophagus and sewing it into place through a small incision. This is done so that the lower portion of your esophagus passes through a small tunnel of stomach muscle. In turn, acid stops backing up into your esophagus as easily, allowing it to heal.

Laparoscopic partial fundoplication is similar to the above procedure but wraps the stomach only part way around the esophagus.

LINX reflux management system is a small flexible band of interlinked titanium beads with magnetic cores. The magnetic attraction between the beads is intended to help your lower esophagus sphincter (LES) resist opening to gastric pressures, preventing reflux from your stomach into your esophagus. The device is designed so that swallowing temporarily breaks the magnetic bond, allowing food and liquid to pass normally into your stomach. The magnetic attraction of the device is designed to close your LES immediately after swallowing.

Hiatal hernia repair is when a surgeon repairs the bulging stomach tissue by placing it back into your abdominal cavity. This can be performed either through traditional surgery or using minimally invasive techniques.

GERD-related laryngeal or pulmonary disease

You use your larynx, or voice box, to breathe, talk and swallow. Gastroesophageal reflux disease (GERD), a disorder where your stomach acid and enzymes back up into your esophagus and injure its lining, can alter the normal structure or function of your larynx. Also, having GERD can cause, trigger or exacerbate many pulmonary diseases.

At the Allegheny Health Network, our highly experienced specialists diagnose and evaluate GERD-related laryngeal and pulmonary diseases so that we can treat your condition most effectively. Our comprehensive team provides a thorough examination and performs tests that provide an accurate diagnosis and then develops a treatment plan customized to your needs.

Hyperhidrosis

Hyperhidrosis is a condition that causes heavy sweating in the palms of your hands, or your face, underarms and sometimes your feet. People with this condition may sweat even when the temperature is cool or when they are at rest. We perform this procedure for severe cases:

Video-assisted sympathectomy is a minimally invasive procedure where a surgeon cuts or clamps your sympathetic nerve chain, which runs along your spine. This prevents your brain from sending signals to the involved areas to make them sweat. Surgeons at Allegheny Health Network perform the procedure through several small incisions and using a tiny camera (thoracoscope) and sleek surgical instruments. The thoracoscope transmits images of the inside of your body onto a video monitor, guiding the surgeon in performing the procedure.

Mediastinal and thymic masses and myasthenia gravis

Myasthenia gravis is a chronic muscular disorder characterized by weakness and rapid fatigue of any of the muscles under your voluntary control. Signs and symptoms include weakness of arm and leg muscles, double vision, drooping eyelids and difficulties with speech, chewing, swallowing and breathing.

Approximately 15 percent of people with myasthenia gravis have a tumor in their thymus gland, located under your breastbone. Mediastinal tumors are benign or cancerous growths that form in the area of your chest that separates your lungs called the mediastinum.

Our surgeons perform these surgeries to remove the masses:

Video-assisted thymectomy is a minimally invasive procedure where a surgeon makes a small incision in your neck and uses a long thin camera (thoracoscope) and sleek instruments to visualize and remove your thymus gland through your neck.

Robot-assisted thymectomy involves a surgeon making several small incisions in the side of your chest and using a robotic system to remove your thymus.

Resection of mediastinal masses is the removal of tumors in area of your chest that separates your lungs.

Mesothelioma

At the Allegheny Health Network Cancer Institute, we have a multidisciplinary team of surgical, radiation and medical oncologists who collaborate to develop an optimal treatment plan for you and your specific cancer. This spectrum of care ensures that you have access to every possible treatment, procedure and clinical trial best suited for your situation.

Mesothelioma is a rare and aggressive cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium). This cancer most often affects the tissue that surrounds the lungs (pleura), but it can also affect tissue in the abdomen and around the heart.

When diagnosed at an early stage, mesothelioma can possibly be cured by surgical removal. But when this is not possible, surgery can instead help to reduce the signs and symptoms caused by the disease. Our surgical options include:

Pneumonectomy includes removing all organs where the mesothelioma has spread. This may include the lung, lymph glands and parts of your diaphragm.

Pleurectomy involves peeling the tumor away from your lungs, ribs, diaphragm, and chest wall while keeping those structures in place. This will not sure the disease, but may relieve symptoms.

Pleurodesis is when a surgeon inserts a tube or catheter into your chest to drain fluid that has built up in your chest. The surgeons may also inject medicine into your chest to prevent fluid from returning.

Pleural diseases

Pleural diseases occur when the pleura – membrane that lines the inner side of your chest cavity and covers young lungs – becomes inflamed and you have difficulty breathing. We provide the following treatment:

Video-assisted pleurodesis is when a surgeon injects a chemical agent into the pleural space so that it irritates the area and eliminates the change for fluid buildup.

Thoracic outlet syndrome

Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the space between your collarbone and your first rib become compressed. This can cause pain in your neck and shoulders and numbness in your fingers. Typically, physical

Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures, but sometimes surgery is needed. We offer this approach:

Transaxillary surgery is when a surgeon makes an incision in your chest to divide the muscles in front of your first rib and remove a portion of it to relieve compression.

Tracheal disorders

The trachea (windpipe) is the airway that extends downward from your voice box. There are various types of cancerous and malignant tracheal diseases, including tracheal tumors, tracheal stenosis and tracheobronchomalacia.

At the Allegheny Health Network Cancer Institute, we have a multidisciplinary team of surgical, radiation and medical oncologists who collaborate to develop an optimal treatment plan for you and your specific cancer. This spectrum of care ensures that you have access to every possible treatment, procedure and clinical trial best suited for your situation.

We offer these procedures and surgeries to treat the disorders:

Tracheal resection and reconstruction is when a surgeon removes the constricted section of your trachea and rejoins the upper and lower sections.

Stent therapy involves placing a narrow tube made out of metal or silicone (stent) in a narrowed or constricted airway to keep it open.

Laser therapy is when a highly focused beam of light is used to shrink or remove the tumor or to remove scar tissue that is causing stenosis.

Brachytherapy is when a bronchoscope is used to help deliver radiation therapy directly to the tumor cells.

 
To find an Allegheny Health Network physician who specializes in thoracic surgery, call 412.DOCTORS (412.362.8677).