Thoracic Surgery

Frederic W. Grannis Jr. MD

A lecture to students at the

Western University of Health Sciences

Pomona CA December 17, 2002

Thoracic Surgery

• Cardiac Surgery– Acquired

– Congenital

• Vascular Surgery– aneurysms

– aortic dissection

• Esophageal Surgery

• General Thoracic Surgery– Pulmonary

– Chest Wall

– Mediastinal

– Pleural

– Pericardial

– Neural

Thoracic Surgery: Pulmonary Surgery

• Infections– TB– Lung Abscess– Bronchiectasis– Fungi– Parasitic

• Trauma– blunt vs. penetrating

• Congenital– cystic fibrosis

• Emphysema

• Neoplasms– Bronchogenic CA– Other malignant tumors– Lung Metastasis– Benign tumors

• Palliative– pleural-pericardial

effusion– airway obstruction

Stop at the Pleura! A Brief History of Thoracic Surgery

Frederic W. Grannis Jr. MD

City of Hope National Medical Center, Duarte, California

H. M. Block

• Experimenteles zur Lungenresection

• von Dr. Block (Danzig)

• Deutsche Medizinische Wochenschrift

• 7:634-6, 1881

Letter from Berlin: Resection of the Lung as Proposed by Dr.

BlockG.L. Walton. Boston Medical and

Surgical Journal, Vol CVII:261-262. February 23, 1883

Bronchoscopy

• Gustav Killian 1898

Physiology of the Open Chest

• 1898 J. B. Murphy

• 1918 Evarts Graham

• Because of the rapidly deteriorating condition of the patient with an open chest, the most important factor in early surgical

cases was time.

Ludolph Breuer

• Uberdruck

1904

Ferdinand Sauerbruch

Unterdruck

1904

Chausier

RibemontGairal

EarlyEndotrachealTubes

Geudel

1928

Endotracheal Intubation

Whelan

Doyen

Fell+O’Dwyer

1898

Meltzer and Auer

New York1909

History of Lung Cancer

• The most salient point in the history of lung cancer is that it was almost non-existent before the twentieth century.

• Adler reported 221 collected cases to 1900 and 374 to 1912.

• Cigarette smoking as etiology first suspected by Soemmerling.

Evarts Graham

Pneumonectomy

1932

Cautery Pneumectomy

Lothar Heidenhain

First resection of a lung cancer

1903

(incidental in lobectomy for bronchiectasis)

Davies

First anatomic dissection c.

1912

Pleurodesis

v. Mickulykz

TourniquetsShenstone

Roberts

Bulau

1873

Pulmonary Resectioncirca 1930

• “There is bleeding and infectious leakage from the lung, and bleeding from the diaphragm. Tight closure of the chest without drainage seems inadvisable under such conditions, and yet necessary to avoid the ills of postoperative pneumothorax. Suddenly, it is obviously time to return the patient to his bed. Not much has been accomplished...And, after all, the greatest dangers occur after the operation.”

Samuel Robinson 1925

“Modern” Pulmonary Resection

• Developed from an international collaborative effort on the part of a number of surgeons and anesthesiologists over a period of approximately 50 years.

• By 1940 thoracic surgeons were prepared to face the new epidemic of lung cancer.

Components of “Modern” Thoracic Surgery

• Anatomic-Pathologic Diagnosis• Endotracheal intubation and positive pressure

ventilation• Anatomic dissection and individual ligation• Secure bronchial closure• Closed pleural suction drainage• Respiratory therapy and ventilatory support• Antibiotic therapy