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