Our expert witnesses in thoracic surgery specialise in surgical intervention on the thorax (chest). They are experts in performing a variety of surgical procedures such as thoracotomy, chest reconstruction, pleurodesis, pneumonectomy, lung volume reduction surgery, and VATS surgery.
Our experts in thoracic surgery have a profound knowledge of managing conditions such as lung cancer, recurrent pneumothorax, pectus excavatum, and disorders of the diaphragm. Further, their extensive experience in the operating theatre means they can review operation notes and assess the practical nature of the surgical procedures performed.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in thoracic surgery can advise on causation, breach of duty, current condition, and prognosis in individuals who have undergone or require thoracic surgical intervention.
See below for a brief overview on thoracic surgery. Alternatively, contact an expert witness in thoracic surgery to see how they can help.
What is Thoracic Surgery?
Anatomy & Physiology
The thoracic cavity is bordered by the ribs, vertebral column, sternum, and diaphragm. Between each rib is the intercostal space, often used to gain access to the thoracic contents. Within the thoracic cavity lie the lungs, which are lined by the pleural sacs. Between the lungs is an area known as the mediastinum.
The mediastinum contains a compartment referred to as the superior mediastinum. This contains the aortic arch, superior vena cava (SVC), vagus nerve, phrenic nerve, thymus, trachea, oesophagus, thoracic duct, and sternohyoid and sternothyroid muscles.
A further compartment within the mediastinum is known as the middle mediastinum. This contains the heart, pericardium (surrounding the heart), bronchi, tracheal bifurcation, ascending aorta, pulmonary trunk, SVC, cardiac plexus, phrenic nerve, and lymph nodes.
Trauma to the thorax can lead to rib fractures, haemothorax (blood accumulation within the pleural cavity), pneumothorax (air within the pleural cavity), or tracheal injury. A tension pneumothorax is a medical emergency which requires the insertion of a chest drain (thoracostomy) to alleviate the increased pressure from the lungs and heart. Following trauma, some individuals can experience what is known as a flail chest, whereby there is a portion of the rib cage which becomes separated from the chest wall.
Some individuals develop primary spontaneous pneumothoraces which are often managed conservatively. However, in some circumstances, the pneumothoraces become recurrent and require surgical intervention with pleurodesis.
Lung & Chest Surgery
Lung volume reduction surgery is performed in individuals who have bullous emphysema and large pockets of trapped air within their lungs. The procedure removes the unhealthy, large sacs of lung tissue, to allow the remaining lung tissue to better function. These individuals may also undergo bronchoscopic lung volume reduction, whereby an endoscope (bronchoscope) is used to placed valves in the airways and block off the majorly affected parts of the lungs.
Thoracic surgery can be performed as video-assisted thoracoscopic surgery (VATS). This is keyhole surgery of the chest.
Individuals who have lung cancer may undergo surgery to remove the tumour(s). This can be performed in one of three ways:
- Pneumonectomy – where one lung is removed in its entirety;
- Wedge resection – where only a small piece of lung is removed. This is often performed pre-diagnosis; or
- Lobectomy – where one or more of the lung lobes are removed.
When an individual is diagnosed with a thymoma (cancer of the thymus gland), they may undergo a thymectomy. This can be done via VATS or may require a median sternotomy, where the sternum is split open.
At the front of the chest, the sternum and ribs usually project out of the chest. Occasionally, through trauma or congenital abnormality, the sternum and ribs project into the chest forming a depression in the chest; this is referred to as pectus excavatum. Although often this has no impact on the normal function of the body, occasionally the depression will be to the extent whereby it compresses the contents of the thoracic cavity. It may also cause individuals to have psychological difficulty. On the other hand, people may be born with pectus carinatum, whereby the sternum is pressed out or upwards; again, this often results in no physical symptoms, however there is an association with spinal problems and again may have psychological impacts. In both cases, surgery in the form of the Nuss procedure or modified Ravitch procedure can be performed to correct the concavity.