I. Introduction Let’s face it, the thought of undergoing surgery can be daunting. But what if I told you there’s a way to achieve the same results with less pain, less scarring, and a faster recovery? Enter Video Assisted Thoracoscopic Surgery (VATS). This minimally invasive procedure is taking the medical world by storm and for good reason. With VATS, doctors can access the chest cavity through small incisions instead of a large open surgery, resulting in less trauma to the body and a quicker recovery time. It’s no wonder that VATS Surgery in India is becoming the go-to option for lung cancer, pleural effusion, emphysema, pneumothorax, esophageal cancer and sympathectomy for hyperhidrosis. So, if you’re facing thoracic surgery, don’t be afraid to ask your doctor about VATS surgery, which is also known as “Keyhole chest surgery” in India. Trust me, you’ll be glad you did. II. The Advantages of VATS A. Less invasive: – VATS is considered less invasive than traditional open thoracic surgery because it uses small incisions ( two or three ) to access the chest cavity, rather than a large open incision. A camera and few long instruments enter the chest through these tiny cuts on the chest. The images are transmitted to a monitor placed in front of the surgeon. The surgeon completes the entire procedure looking at the monitor while manoeuvring his instruments in the chest cavity. This results in less trauma to the body, and less bleeding during the procedure. Not only is the incision small, but also there is no cutting of muscles and spreading of ribs. In recent times the number of small cuts have also decreased with many surgeries now possible with only one tiny incision (Uniportal VATS surgery) – According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean blood loss of 27.4 ml, compared to 199.4 ml for patients who underwent open thoracic surgery. B. Faster recovery time: – One of the most significant benefits of VATS surgery is the faster recovery time compared to traditional open thoracic surgery. According to a study published in the Journal of Thoracic Disease, patients who underwent VATS had a mean recovery time of 7.4 days, compared to 12.8 days for patients who underwent open thoracic surgery. This can be attributed to the smaller incisions and less tissue damage associated with VATS. Another study published in the Journal of Surgical Oncology found that patients who underwent VATS for lung cancer had a mean hospital stay of 4.1 days, compared to 7.2 days for patients who underwent open thoracic surgery. This is a significant reduction in recovery time, allowing patients to return to normal activities sooner. C. Reduced pain:     – According to a study published in the Journal of Cardiothoracic Surgery, patients who underwent VATS reported less pain and discomfort compared to those who underwent open thoracic surgery. Again this could be attributed to the smaller size of the incision, avoidance of muscle cutting and rib spreading. The intercostal nerve bundle which runs beneath each rib is also at a lower risk of damage in VATS surgery as compared to an open surgery. In open thoracotomy a rib spreader is used to separate the ribs and if the surgeon is not careful enough the intercostal nerve is likely to get damaged with the metallic spreader leading to pain as well as paraesthesias.     – The study found that the mean visual analogue scale (VAS) score for pain was 2.9 for VATS patients, compared to 4.2 for open thoracic surgery patients. D. Minimized scarring:     – Smaller incisions used in VATS surgery result in less visible scarring compared to open thoracic surgery. This can be especially important for patients who are concerned about their appearance after surgery. Not only are the incisions kept smaller but are also strategically placed on the chest so as to keep them in the bra-line for females.     – According to a study published in the Journal of Thoracic Disease, the mean length of incisions for VATS was 3.7 cm, compared to 13.2 cm for open thoracic surgery. E. Improved outcomes:     – VATS surgery has been shown to have similar or better outcomes compared to open thoracic surgery. This includes similar or better survival rates, similar or better lung function, and similar or better quality of life.     – A study in the Journal of Thoracic Disease found that the 5-year overall survival rate was similar for VATS and open thoracic surgery patients (78.5% vs. 78.9%). III. VATS Surgery in Action Testimonials from patients who have undergone VATS surgery in India IV. VATS Surgery in India for Various Thoracic Conditions A. VATS Surgery for Lung cancer: -The surgical treatment of lung cancer is anatomical resection of the part of lung having the cancer as well as removal of draining lymph nodes. This may be in the form of segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy etc combined with mediastinal lymph node dissection. All of these anatomical resections are possible by VATS in the hands of an experienced surgeon. A special kind of lung cancer known as Neuroendocrine tumours of the lung (Carcinoids) are also amenable to VATS or keyhole chest surgery. B. VATS Surgery for Pleural Effusion and Empyema: – VATS is an effective option for the treatment of pleural effusion or empyema, a condition in which fluid or pus builds up respectively, in the space between the lung and the chest wall. In this surgery all the fluid or pus surrounding the lung along with pus flakes or debris is evacuated which decreases the infective load from the chest. It also helps to relieve the pressure that had caused the underlying lung to collapse. Sometimes a decortication process would be required to help the lung expand by removing the thick peel that forms around the lung and entraps it. – VATS for pleural effusion and empyema offers significant improvement in the breathing and quality of life after the procedure.

Introduction Lung bullae, also known as pulmonary bullae, are air-filled spaces in the lungs that are larger than normal air sacs. Blebs are air-filled collections within the layers of the visceral pleura and are <1 cm in diameter. Bullae can be caused by conditions such as emphysema, smoking, and genetic predisposition. These spaces can become enlarged, leading to symptoms such as shortness of breath, chest pain, and fatigue, which may require VATS bullectomy or lung bulla surgery. In India, lung bullae are a prevalent condition, with estimates suggesting that up to 4% of the population may be affected. According to recent studies, lung bullae are found in about 20% of patients with chronic obstructive pulmonary disease (COPD) and about 2% of patients with asthma. One of the most common treatments for lung bullae is VATS bullectomy surgery. In this article, we will take a closer look at VATS bullectomy surgery in India, including the procedure, indications, advantages, cost, and recovery. Causes and risk factors for lung bullae Symptoms of lung bullae Diagnosis of lung bullae Treatment options for lung bullae The treatment options for lung bullae vary depending on the size and location of the bulla, and the severity of symptoms. Medical management: Medical management may include bronchodilators, corticosteroids, and oxygen therapy Surgical options: Bullectomy surgery and bulla resection are surgical options for treating lung bullae. VATS bullectomy surgery is a popular and effective minimally invasive option that involves the removal of the bulla through small incisions in the chest. VATS Bullectomy Surgery: A closer look It is important to understand that not everybody who has bullae requires surgery, and surgery is not appropriate for everyone. VATS bullectomy surgery is typically recommended for patients with large bullae that are causing symptoms. A thoracic surgeon is most likely to recommend a bullectomy for patients who: Patients who have multiple bullae throughout the lungs (diffuse disease) may not be good candidates for bullectomy because surgery may cause more damage to surrounding tissue and a lot of lung volume is lost in resection. The procedure: Video Assisted Thoracoscopic Surgery (VATS) bullectomy is a minimally invasive procedure that uses small incisions on the chest wall but needs patient to be under General Anaesthesia. The number of incisions can be one (Uniportal VATS) or two/three (Standard VATS). A camera is introduced through one of the cuts to inspect the lungs and pleural cavity. The region of lung containing the bullae is identified. A leak test is also performed to identify any other source of air leak. Surgical staplers are then used to resect the bullous component and/or the area of air leak, with a margin of healthy underlying lung. Pleurodesis: Bullectomy must always be supplemented with an additional procedure of pleurodesis. It is the process of fusing the two layers of pleura together so as to obliterate the space between the lung and the chest wall. This is very important to reduce the incidence of recurrence of pneumothorax as new bullae and blebs may form lifelong in these patients and may rupture to cause collection of air outside the lungs. Pleurodesis can be: Recovery and follow-up: Patients typically stay in the hospital for a few days after VATS bullectomy surgery and may need to avoid certain activities for a few weeks while they recover. After the procedure, the person will have one or two tubes coming from the side of their chest. These tubes attach to a machine that helps suck out air and fluid from this area of the body. Once the drainage has reduced and air leak has stopped, the surgeon will remove the chest tubes safely. Advantages and disadvantages: Advantages of VATS bullectomy surgery include a shorter recovery time, less pain, and fewer complications compared to traditional open surgery. Disadvantages include the cost of the procedure and the need for general anesthesia. Cost of VATS Bullectomy Surgery in India The cost of VATS bullectomy surgery in India can vary depending on factors such as the location of the hospital, the surgeon’s experience, and the patient’s insurance coverage. VATS Bullectomy requires the usage of surgical staplers. The number of stapler fires would depend on the size of the bulla that needs to be resected. The higher the number of fires, greater the cost of the surgery would be. Comparison with other countries: The cost of VATS bullectomy surgery in India is typically lower than in other countries. Insurance coverage: Many insurance plans cover at least a portion of the cost of VATS bullectomy surgery. Conclusion VATS bullectomy surgery is an effective and minimally invasive option for treating lung bullae in India. Patients should be well-informed about the procedure and its cost before making a decision. Early diagnosis and treatment can lead to better outcomes and improved quality of life for patients with lung bullae. You can get in touch with Dr. Kamran Ali and his team for any lung bullae related query.

Neuroendocrine tumours (NETs) of the lung are a rare type of lung cancer that arise from the cells called Kulchitzky cells of the bronchial mucosa . A few lung NETs can make high levels of hormone-like substances. If these substances are released in high amounts in the blood, the tumour is called a “functional” NET and it will cause a group of symptoms called Carcinoid Syndrome. These tumours can be benign or malignant and can cause a wide range of symptoms, depending on the location and size of the tumour, as well as the hormones that it produces. Classification NETs of the lung are classified into the following types: Clinical profile of NETs of Lung The clinical spectrum of neuroendocrine tumors (NETs) of the lung is diverse and can range from asymptomatic, indolent tumors to rapidly growing malignancies. Symptoms of NETs of the lung can include: Diagnosis Most of the time lung NETs are found unexpectedly when people have annual health check-ups or imaging tests or a medical procedure done for reasons unrelated to the tumor. If a doctor suspects this disease, they will elicit a complete medical and family history and perform a complete physical examination. Tests required to diagnose a lung NET: Pathologic findings of NETs of the lung These lesions are characterized by the presence of neuroendocrine cells (small cells with round nuclei and moderate amount of cytoplasm) arranged in a trabecular, organoid, or solid pattern. The cells may be arranged in nests, cords, or trabeculae. The degree of differentiation is an important prognostic factor for NETs, the well-differentiated tumors have better prognosis than poorly differentiated ones. Immunohistochemistry is important to establish a diagnosis of NETs of the lung, The most commonly used markers are chromogranin, synaptophysin and CD56. The Ki-67 index, which measures the proliferation rate of the tumour cells, is also used to evaluate the aggressiveness of the tumour. NETs of the lung are graded based on the degree of differentiation, the Ki-67 index, and the mitotic count. The grading system is important for prognosticating the disease and for planning treatment. Radiological features Chest radiographs: NETs appear as solitary, round or oval-shaped nodules that can be well-circumscribed or spiculated. They can also appear as multiple nodules or as a mass that can be associated with atelectasis, pleural effusion or lymphadenopathy. Computed tomography (CT) scans: NETs of the lung can have a variety of appearances, including solid, ground-glass, or cystic. They may show central or peripheral enhancement after administration of IV contrast. Carcinoid tumours appear as a spherical or ovoid nodule or mass with a well-defined and slightly lobulated border. When nonspherical, the tumour is elongated with its long axis parallel to adjacent bronchi. Calcification or ossification is seen in up to 30% of cases. Positron Emission Tomography (PET) scans: A special form of PET scan is used to evaluate NETs of Lungs. They are called DOTA-NOC PET scan that uses a radioactive tracer called Ga-68 dotatate to bind to a tumour’s somatostatin receptors. Ga-68 dotatate is injected intravenously and then patients undergo the scan. NETs of the lung tend to have a high uptake of this radiotracer, indicating increased metabolic activity. Treatment Treatment options for neuroendocrine tumours (NETs) of the lung vary depending on the stage and grade of the tumour, as well as the patient’s overall health. Surgery: Surgery is the primary treatment option for localized NETs of the lung. The goal of surgery is to remove the tumour and surrounding tissue with a healthy non diseased margin. Most localized (early stage I to II and some stage III) lung NETs require only surgery. Depending on the size and location of the tumour, different surgical procedures may be used, such as lobectomy, segmentectomy, pneumonectomy or wedge resection. The surgeon will also remove the surrounding lymph nodes. In case of a Bronchial Carcinoid a lung parenchyma preserving surgery like Sleeve Lobectomy may also be done. Endoscopic management of intraluminal Carcinoids like rigid bronchoscopic resection has also been described in literature but surgery remains the gold standard. Radiation therapy: The most common type of radiation treatment for a lung NET is called external-beam radiation therapy (EBRT). Its role is mainly palliative to relieve symptoms, such as pain, caused by cancer that has spread to other areas of the body. Chemotherapy: is most often used when the tumour has spread to other organs, is growing quickly, or is causing severe symptoms. The response to chemotherapy is not that great. Most common agents that are used are: Targeted therapy: Targeted therapy is a newer type of treatment that targets specific molecules involved in the growth and spread of cancer cells. Everolimus is the only targeted therapy approved by the FDA currently for the treatment of lung NETs. Peptide receptor radionuclide therapy (PRRT): This treatment uses a small amount of radioactive material that is attracted to the receptors on the tumour cells. This treatment is used for advanced or metastatic NETs. Its use in lung NETs is limited to clinical trials and the FDA has not yet approved it. Embolization- Hepatic artery embolization: This is a procedure that blocks the blood supply to the tumour, which can shrink it or slow its growth. Conclusion It’s important to note that treatment plans for NETs of the lung are usually tailored to the specific needs of each patient and may involve a combination of these treatments. It is important to consult with a specialized team of doctors to determine the best treatment option for an individual patient.

Lung cancer is one of the most common cancers and it affects millions of people in India every year. It is one of the leading causes of cancer-related deaths. The number of cases have also been on the rise, including in non-smoker population. 1 in 16 people will be diagnosed with Lung cancer in their lifetime. The rising incidence and delayed diagnosis of lung cancer in India are grave concerns. For those who are suffering from this condition, finding the best lung cancer surgeon in Delhi is crucial in order to get the best treatment. In this article we will try to present all the important information about lung cancer and its treatment, including surgery and other options. We will also try to highlight the important factors to keep in mind while choosing your treating physician. Introduction to Lung Cancer Abnormal and uncontrolled growth of cells in the lung tissue can lead to formation of lung cancer. The cancer that originates in the cells of the lung is called a “Primary Lung Cancer” and if the cancer cells reach the lung from some other organ, it is called a “Secondary Lung Cancer“ Broadly, Primary lung cancers are classified into 2 main types, based on the cell of origin: NSCLC is the most common type of lung cancer, accounting for approximately 80 – 85% of all cases. The three main varieties of NSCLC are: SCLC occurs in about 15-20 people out of 100, mostly in smokers. It is a type of Neuroendocrine tumour (NET). It is characterised by a rapid spread of tumour in the body. Lung cancer is the 2nd most common cancer in the world (most common in men, 2nd most common in women), according to Global Cancer Observatory (World Health Organization). Read more about Lung cancer statistics here. It is also one of the leading causes of cancer-related deaths in India. Lung cancer kills almost 3 times as many women as Breast cancer, and almost 3 times as many men as Prostate cancer Smoking is the most common risk factor for lung cancer. Other risk factors for lung cancer include second-hand smoke, exposure to certain chemicals, air pollution, radon gas and asbestos exposure, genetic predisposition, underlying lung disorders like COPD, arsenic in drinking water and increasing age. Symptoms of Lung Cancer The symptoms of lung cancer vary depending on the type and stage of the disease. Early signs of lung cancer may include: Read more about: Symptoms of Lung Cancer Lung Cancer Signs & Symptoms Causes of Lung Cancer Smoking is the number one cause for development of lung cancer. Cigarette smoke contains thousands of dangerous chemicals, out of which about 70 are cancer causing agents. Cigarette smoke is responsible for about 80% to 90% of all lung cancer cases in India. There is also a lot of Bidi and Hukka smoking in India as well. Second-hand smoke: Adults who are exposed to second hand smoke have a 20-30% risk of developing lung tumours. Other risk factors for lung cancer include exposure to certain chemicals, air pollution, asbestos exposure, increasing age, family history, previous lung diseases like COPD, exposure to Radon gas, arsenic in drinking water etc. Diagnosis of Lung Cancer The diagnosis of lung cancer requires a detailed history and a complete physical examination in the clinic. If your doctor suspects lung cancer you will be asked to undergo a battery of investigations. These may include: Treatment Options for Lung Cancer The type and stage of lung cancer decides the treatment. The options available are: Surgery for Lung Cancer Surgery is the first-line choice for early stage lung cancer which means when the tumour has not yet spread beyond the lungs. When done timely surgery has the potential to cure the patient completely. But unfortunately very few lung cancers that present to doctors are operable due to delayed diagnosis. Since it is a complicated surgery you should opt for the best lung cancer surgeon in Delhi or your city. Radiation therapy Radiation therapy uses high-energy X-rays or other particles to kill cancer cells and shrink tumours. Chemotherapy It is a form of treatment that is used to kill cancer cells. Anti-cancer medications are administered in the vein, and the session lasts up to a few hours. The treatment is performed in cycles of 1-3 weeks. It can be given pre-surgery, post-surgery or even as definitive treatment alone or with radiation therapy. Targeted therapy It is a type of treatment that uses drugs to target specific cancer cells. So your doctor may recommend molecular targeted therapy that includes the administration of drugs that work in subsets of patients whose tumours have specific genetic changes that have the potential of promoting tumour growth. Proton therapy Proton therapy is a type of radiation therapy that uses protons instead of X-rays to treat cancer. It can be used to treat lung cancer, but it’s relatively new, and not all centers have the capability to provide it. Immunotherapy Immunotherapy is a type of treatment that helps the body’s immune system to fight cancer. It can be used alone or in combination with other treatments. Checkpoint inhibitors: These drugs block certain proteins on the cancer cells that help them evade the immune system.CAR T-cell therapy: This is a type of immunotherapy that involves removing T cells from the patient’s blood, altering them in a lab to recognize and attack cancer cells, and then infusing them back into the patient. Supportive Care Supportive care is an essential part of lung cancer treatment. It includes measures to control symptoms, improve quality of life, and prevent complications. It can include: Finding the Best Lung Cancer Surgeon in Delhi This can be a daunting task because there are many surgeons in the city. So it can be difficult choice to make. To find the right or best lung cancer surgeon in Delhi or your nearby city is to do some research and ask for referrals from your doctor or other healthcare professionals. Once you have zeroed

Empyema Surgery in Delhi is now very easily possible. Empyema thoracis is a serious medical condition in which pus accumulates in the pleural space of the lungs. It is a life-threatening condition that can be caused by a bacterial infection, tuberculosis, a foreign body in the chest, or a complication of another medical condition. The underlying cause of empyema must be identified and managed before proceeding with any treatment. Surgery is often recommended to remove the infected pus and to restore normal lung function. This type of surgery can be a complex and lengthy procedure that requires the expertise of a thoracic surgeon. In this article, we will discuss what is empyema and how surgery can help treat it. We will review the different types of surgeries available and explain how a thoracic surgeon can help you manage your condition. What is Empyema Thoracis? Empyema is a medical condition in which pus collects in the pleural space of the lungs. An empyema is classified as a suppurative lung infection. Suppuration is the formation of pus. Because it is a serious condition so it requires prompt diagnosis and treatment since it can be fatal. The pleural space is the area outside the lungs where the pleural membranes (lung membranes) surround the lungs. The pleural membrane is a thin sheet of tissue that covers the inside of the chest wall and the outside of the lungs. It is made up of two layers – the parietal layer and the visceral layer. The visceral layer lines the outer surface of the lung and the parietal layer lines the chest wall. The pleural space is normally filled with a small amount of a clear, thin fluid that lubricates the inside of the chest, allowing the lungs to move back and forth during breathing. Often patients need surgery for empyema thoracis if they cannot be managed conservatively. Causes of Empyema It can result from a variety of bacterial infections that spread from the chest into the pleural space. Pleural empyema can result from an existing lung infection, such as tuberculosis or bacterial pneumonia. It can also occur after a lung infection that has been treated with antibiotics. This can occur if the infection is not completely eradicated or if the antibiotics are not effective against the infecting bacteria. Other common reasons are: Stages of Empyema and Stage-wise Treatment of Empyema in Delhi The evolution of Empyema goes through three stages. First Stage: The first is the presence of free-flowing fluid (effusion) which usually resolves with antibiotics and non-invasive treatment. If it is left untreated the effusion becomes complicated. Second Stage: In this there is a deposition of fibrin and membranes which leads to formation of septations or loculations in the fluid leading to comparmentalization of the fluid into different pockets. Both antibiotics as well as some form of pleural drainage is required in this stage. Third Stage: If the loculated fluid is not drained the fluid will start organising (third stage) into thick pus and the fibroblasts will coalesce to form a thick pleural peel between the visceral and parietal pleura. This peel can ultimately encase the underlying lung and will prevent the lung from expanding. For an easy understanding the collapsed underlying lung can be compared to an orange and the thickened pleural peel around the lung to the peel of the fruit. This stage requires Surgery for Empyema Thoracis because the lung is usually trapped and unable to expand. Symptoms & Signs The symptoms of empyema vary depending on the underlying cause and the extent of the infection. Most patients experience symptoms similar to pneumonia, including fever, chills, cough, chest pain, and difficulty breathing. Other symptoms of may include chest pain behind the breastbone, pleuritic pain (pain that worsens when taking a deep breath), and low oxygen levels in the blood. As the infection spreads, patients may experience sweating, high fevers, and general weakness. Patients who may be experiencing symptoms of empyema should consult a health care professional so as to determine the cause of their symptoms. A health care professional can perform a physical examination, take a medical history, and order diagnostic tests like a Chest X ray, CT scan and analysis of the pleural fluid/pus. If Pleural Empyema is diagnosed, it may need surgery. Surgery for Empyema in Delhi In many cases, empyema thoracis requires surgical treatment. A thoracic surgeon will examine the patient to identify the extent of the infection and the location of the pus. They will review the patient’s medical history and current medications to determine the best treatment plan. The surgery for empyema thoracis is called “Drainage and Decortication” The goals of this surgery are: Traditionally the approach used for empyema surgery is an open approach called a “Thoracotomy”, which is a large cut on the side of the chest and involves cutting the muscles and spreading the ribs. This allows the surgeon to put his hands inside the chest to operate. Decortication Surgery for Empyema in Delhi Dr. Kamran Ali does most of his Empyema operations by a minimally invasive technique called Video Assisted Thoracoscopic Surgery (VATS). This technique involves making tiny key hole cuts on the side of the chest (1 to 3), without muscle cutting or rib spreading. With the help of a camera (thoracoscope) and double hinged long working instruments, the whole surgery can be completed by looking at a monitor. So all goals of an empyema surgery that can be achieved by an open surgery can be safely replicated by VATS. Uniportal VATS Drainage and decortication of empyema is a special type of VATS surgery, because it utilizes only a single 3-4cm incision to perform this surgery. Occasionally these surgeries may not be possible by VATS but would need a conventional open surgery approach especially when the pleura has calcified or in case of fibrothorax. Advantages of Surgery for Empyema (in Delhi) by VATS VATS decortication usually translates to lesser post operative pain, faster recovery and a shorter hospital stay. It