Thoracic and Pulmonary Surgery

The Thoracic and Pulmonary Surgery Unit (C.O.U. Chirurgia 2 Toraco Polmonare) is an integral part of the Lung Unit, working in collaboration with the C.O.U. of Oncology, Internal Medicine, Pathology, Imaging Diagnostics, and Radiotherapy. A dedicated multidisciplinary panel evaluates cases to determine: Indications for direct surgical intervention, Preoperative neoadjuvant chemotherapy or radiotherapy for advanced disease, Postoperative care and follow-up protocols. The Unit also participates in the Thyroid Unit, focusing on the treatment of differentiated thyroid carcinoma and medullary thyroid carcinoma, including cases linked to multiple endocrine syndromes. This team oversees surgical indications, follow-up planning, and postoperative management.

Since 2015, surgeries for hiatal hernias and functional disorders of the gastroesophageal junction have been performed almost exclusively using robot-assisted minimally invasive laparoscopic techniques.

The Unit performs procedures across the following care settings:

Day Service

Abdominal wall hernia repairs.
Excision of skin and subcutaneous lesions

Outpatient Clinic

Specialist consultations and scheduling of inpatient and Day Service procedures.
Follow-up care for operated patients

Indicators: 758 total annual procedures (2021 data)

Oncologic Thoracic and Pulmonary Surgery

Surgical interventions include lobectomy, pneumonectomy, and pleuropneumonectomy with lymphadenectomy, performed via thoracotomy for:

Malignant pleuropulmonary tumors

Diagnostic thoracoscopy with biopsy or atypical pulmonary resection is utilized for:

Characterization of suspicious lesions or pleural carcinomatosis.
Biopsy of inaccessible mediastinal lymph nodes.
Palliative management of malignant pleural effusions.
Pulmonary metastases.

Surgery for Benign Thoracic and Pulmonary Conditions

Minimally invasive thoracoscopic resections are performed for:

Bullous emphysema.
Spontaneous pneumothorax.
Recurrent post-traumatic pneumothorax following emergency pleural drainage.

Minimally invasive thoracoscopic surgery for:

Pleural empyema

Mediastinal Surgery

Thymectomy is performed for:

Benign thymic lesions are managed using minimally invasive robotic techniques in accordance with established literature guidelines, or:

Cystic formations.
Malignant thymic neoplasms, treated via sternotomy.

Diaphragmatic Surgery

Procedures include repairs for:

Diaphragmatic eventration (relaxatio diaphragmatica).
Diaphragmatic hernias.

Thyroid and Parathyroid Surgery

Thyroidectomy is performed for:

Benign conditions (e.g., goiter, hyperthyroidism) or lobectomy.
Differentiated thyroid carcinoma or medullary carcinoma, with associated radical lymphadenectomy.

Parathyroidectomy is performed for:

Primary, secondary, or tertiary hyperparathyroidism, with intraoperative PTH monitoring.
Parathyroid malignancies.

Procedures for esophageal or tracheal resection are undertaken when necessary for:

invasive thyroid or parathyroid tumors.

Chest Wall Surgery

Nuss thoracoplasty for pectus excavatum.
Post-traumatic chest wall reconstruction.
Excision of osseous and cutaneous tumors.

Surgery for Primary Hyperhidrosis

Thoracoscopic sympathectomy

Esophageal Surgery

Myotomy with fundoplication for achalasia (video-assisted).
Fundoplication for pathological gastroesophageal reflux, with or without hiatal hernia (video-assisted).
Excision of benign esophageal tumors.