KOCHI: The advent of new technology has helped both the patient and doctor alike. One of the recent advances in cardiothoracic surgery has been VATS or Video Assisted Thoracoscopic Surgery. There are very few doctors who are yet to adopt and use this technology, but cardiothoracic surgeon Nasser Yusuf has been using it to successfully operate upon patients. “The biggest advantage has been that it is a keyhole surgery and hence very helpful to the patient as far as his recovery and post-operative complications are concerned.”
Kozhikode-based Dr Yusuf, who is also a consultant at the Ernakulam Medical Centre, recently demonstrated this at the 12th National Conference on Pulmonary Diseases in Jodhpur. It was the first live workshop on thoracoscopy, where Dr Yusuf performed a surgery on 63-year-old Ghani Khan who had recurrent pleural effusion (collection of fluid in the chest) which remained undiagnosed. The surgery was performed through a one-inch incision on the side of the chest. According to Dr Yusuf, thoracoscopy provides an accurate diagnosis and facilitates proper treatment of fluid accumulation in the chest may it be due to any form of cancer, tuberculosis, kidney failure or liver disease. This procedure, which will offer relief to thousands of patients, also aids the diagnosis of tumours, pneumonia, sarcoidosis, diffuse lung disease and tuberculosis of the lung.
About 1200 chest physicians were present to watch the surgery at NAPCON 2010. The conference was attended by doctors from all over India as well as from countries like Germany, France, USA, Turkey and Japan. “Of course, it takes a lot of skill as far as the surgeon is concerned. The surgery is performed with a 30 cm-long incision on the back and side of the chest,” he said. Post-operative conditions like pneumonia, collapse of lung, pain, wound dehiscence and bleeding rarely occur. Collection of fluid in the lung is a common condition seen due to cancer, tuberculosis, infection etc. But, most often, a good number of patients are treated without proper diagnosis and therefore receive inadequate treatment. “Very often, they reach us when the disease is in a critical stage,’’ he says. Dr Yusuf says that VATS has helped in tissue diagnosis by helping to collect the tissue directly.
Tissue diagnosis of mediastinal, lung or pleural lesions including Solitary Pulmonary Nodule is certain when all other methods fail. ‘’There is a general belief that the colour of the fluid found in the chest indicates the nature of disease - haemorrhagic in cancer and straw coloured in TB. VATS has clearly proved that this is not always true, that haemorrhagic could mean TB and straw-coloured could harbour cancer,’’
Dr Yusuf explains. Yet another new technique is mediastinoscopy, which is the examination of the central portion of the chest endoscopically. Biopsy of tumours or lesions behind the sternum, adjacent to the heart and great blood vessels can easily be accessed.
In India, the common causes of tumours in this region are cancer, tuberculosis and lymphoma. Mediastinoscopy has demonstrated that sarcoidosis, an easily treatable condition, exists in Kerala. “A 2.5 cm incision is made in the lower part of the neck just above the sternum. The alternative is a 20 cm inch sternal splitting incision in the middle of the chest,’’ he says.
While over 1000 patients have benefited from VATS and mediastinoscopy in Kerala, Dr Yusuf says that training needs to be given to more doctors to use the equipment. “But all this is possible if you have an efficient nursing team to back your effort as a surgeon. It is in the post-operative care that most of the patients make a recovery.’’
(Dr Nasser Yusuf is a consultant at Baby Memorial, PVS And Chest Hospitals in Kozhikode)
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