Surgery/ Thoracic surgery
General thoracic surgery is the field of medicine whose main point of interest is surgical management
of the diseases of the thorax (except for cardiac pathologies). It encompasses, first of all, the
consequences of thoracic injuries, infections and malignant diseases of the lung, pleura and
mediastinum, and chest wall deformities. General thoracic surgery is strictly connected with the
fields of medicine such as pathophysiology of the respiratory system, pathomorphology, general
surgery, pneumonology and oncology.
Teachers:
prof. Janusz Kowalewski
Dr n. med. Mariusz Bella
Lek. Paweł Wnuk
Contact: kowalewskij@co.bydgoszcz.pl
Syllabus
I.
Name of the unit: Lung Cancer and Thoracic Surgery Department
II.
Head of the unit: Prof. Janusz Kowalewski
III.
Faculty of Medicine, Medical Program, year 6
IV.
Course Coordinator: Prof. Janusz Kowalewski
V.
Form of classes: lecture, exercises
VI.
Form of crediting: Credit with grade, 3 ECTS points
VII.
Number of hours: lecture (12h), exercises (30h) – 42 hours in total
VIII.
Topics:
Chest injury, trauma and emergency;
Diagnostic imaging of thoracic diseases;
Lung cancer: modern diagnostic and therapeutic approach;
Mediastinal tumors;
Purulent diseases of the chest;
Congenital defects and other deformities of the chest wall;
The importance of minimally invasive surgery and palliative care in thoracic surgery;
IX.
Booklist:
Thomas W. Shields. General Thoracic Surgery. Seventh Edition 2009.
F. Griffith Pearson. Thoracic Surgery. Second Edition 2002.
Brief
description:
General thoracic surgery is the field of medicine whose main point of
interest is surgical management of the diseases of the thorax (except for
cardiac pathologies). It encompasses, first of all, the consequences of
thoracic injuries, infections and malignant diseases of the lung, pleura
and mediastinum, and chest wall deformities. General thoracic surgery is
strictly connected with the fields of medicine such as pathophysiology of
the respiratory system, pathomorphology, general surgery,
pneumonology and oncology.
Full description:
The classes of general thoracic surgery at the Faculty of Medicine, NCU
are delivered in the form of lectures and practical excercises.
Subjects of lectures:
1. Thoracic trauma (two lectures).
The purpose of the lectures is to present the life threatening
consequences of thoracic trauma (tension pneumothorax, sucking chest
wound, flail chest, cardiac tamponade, injuries of great vessels or
trachea) and potentially life threatening ones (oesophageal and
diaphragmatic injuries, pulmonary contusion, mediastinitis). The
mechanisms of cardiopulmonary disturbances accompaning thoracic
trauma and methods of thoracic injuries management and their timing
are discussed in details. Indications and the technique of chest tube
insertion, therapeutic thoracentesis and pericariocentesis are also
presented during the lecture.
2. Carcinoma of the lung (two lectures).
The etiology, clinical presentation, diagnostic methods and the
management of lung cancer dependently on its staging are presented in
the lecture. The surgical aspect of the malignancy is discussed especially
thoroughly (bronchoscopy, videothoracoscopy, surgical lung resections
and combined therapy)
3. Suppurative thoracic diseases (two lectures).
The lectures acquaint students with the diagnosis and management of
lung abscess, pleural empyema, bronchiectasis and mediastinitis.
4. Imaging diagnostic studies in thoracic diseases.
The lecture presents contemporary imaging techniques for diagnosis of
trauma, malignancies and inflammatory diseases of the chest (x-ray, CT,
MRI, PET/CT, bronchoscopy)
5. Solitary pulmonary nodule.
Definition of solitary pulmonary nodule, its etiology and diagnostic
management.
6. Tumours and cysts of the mediastinum.
The lecture familiarizes students with the definition and compartments
of the mediastinum and the terminology of mediastinal tumours and
psedotumors. Thymomas, teratomas, germinal tumours, neurogenic
tumours, retrosternal and mediastinal goitre are discussed in details.
7. Minimally invasive thoracic surgery.
The indications for and technique of mediastinoscopy,
videothoracoscopy,VATS, bronchoscopy, AFI bronchoscopy and EBUS
are presented. Separate types of procedures performed with the
aforementioned techniques are discussed.
8. Palliative thoracic surgery.
The lecture presents the strategy of management in the cases of recurrent
malignant pleural effusion, malignant stenosis of the trachea, main
bronchi and oesophagus, and thoracic pain caused by neoplastic
tumours.
9. Congenital thoracic wall deformities.
Issues concerning surgical treatment (indications, surgical techniques,
cosmetic outcome) of funnel and pigeon chest are elaborated in the
lecture
During practical excercises students participate actively in all forms of
work done by a thoracic surgeon on the ward.
1. Operating theatre.
Students can observe surgical procedures, ask questions and receive
detailed explanations. Some students are allowed to assist a surgeon.
2. Outpatient clinic of thoracic surgery
Students are acquainted with ambulatory form of medical care (physical
examination, qualification to treatment, medical documentation, followup)
3. Bronchoscopic room
Students can observe bronchoscopy and get to know how to do it
properly (indications, preparation of a patient, diagnostic and therapeutic
value). They have also an opportunity to familiarize with modern
bronchoscopic techniques such as autofluorescence bronchoscopy (AFI),
endobronchial ultrasound with transbronchial needle aspiration
(EBUS/TBNA)
4. Two excercises by a patient's bed.
Each student is obigated to analyse a medical history of patients
hospitalized on the thoracic surgery ward and be familiar with diagnosis
and treatment planned for the patients. One gets to know which
diagnostic methods and surgical or pharmacological therapy were used
in a patient. Students actively take part in the changing of dressings and
removing of chest tubes.
Bibliography:
1. "Thoracic Surgery"; F. Griffith Pearson; second edition 2002.
2. "General Thoracic Surgery" Thomas W. Shields; 2009.
Learning
outcomes:
A student can define, diagnose and institute an efficient treatment for
pneumothorax (tension, open and closed pneumothorax), cardiac
tamponade and flail chest. One knows diagnostic rules and management
of cardiac and pulmonary contusion, oesophageal perforation and
diaphragmatic rupture. One can understand the mechanism of
subcutaneous emphysema after thoracic trauma and knows how to treat
it. One is able to diagnose multifocal and multiorgan injuries.
A sudent knows the mechanisms of lung abscess and pleural empyema
formation, mediastinitis, bronchiectasis and pulmonary mycosis and has
knowledge how to diagnose them and treat them sugrically.
A student comprehends the etiology of lung cancer and pleural
malignant mesothelioma. One is efficiently suspicious if a patient
presents signs and symptoms that could be caused by lung cancer. One
knows rules of imaging and edoscopic diagnostics of this malignancy
that are a basis for its TNM staging and has knowledge of the staging
system. A student is able to qualify a patient with lung cancer to a proper
treatment dependently on its staging. One is concious of the importance
of follow-up in patients treated for lung cancer.
Each student knows diagnostic management of a single pulmonary
nodule on the basis of x-ray, CT, PET-CT, FNAB, bronchoscopy and is
familiar with the way how to proceed dependently on its morphological
features and a patient's history.
A student can define such terms as mediastinum, mediastinal tumours
and pseudotumours, mediastinitis (dependently on a mediastinal
compartment). One realizes when a microscopic verification of a tumour
is necessary and when a mediastinal tumour should be treated surgically.
A student is capable of defining terms such as videothoracoscopy,
mediastinoscopy, mediastinotomy, mediastinal and pleural drainage, and
is able to present their practical implementations. One knows the kinds
of pleural drainage, the procedure of a chest tube insertion and
conditions for its cessation.
A student has a knowledge of the management of recurrent pleural
effusion. One can perform thoracentesis and define conditions for
pleurodesis. One knows the possibilities of a palliative restoriation of
airways patency.
A student is able to diagnose properly a funnel and pigeon chest, to list
indications for sugrical treatment of them and present surgical
procedures for the correction of the chest wall deformities.
Assessment
criteria:
Students are assessed during each class on the basis of answers to
questions, commitment to classes and skills in practical excercises.
Theoretical preparation to a class in accordance with its subject is
obligatory.
After the completion of lectures and classes an oral exam is taken in the
head of the department. . A student draws a set of questions (problem,
descriptive, practical) and should answer them. First of all, the ability of
solving specific medical problems, connection of theoretical knowledge
with real situations one can meet at the place of an accident, in an
emergency unit, outpatient clinic or thoracic surgery ward are assesed.
Besides a student's knowledge of the pathophysiology and management
of thoracic trauma, chest wall deformities, inflammatory and malignant
diseases of the thorax is assessed.