Thoracic Surgery Department
We believe that patients and families visiting this webpage feel great concern about their diseases. Our department strives to provide patients with thorough explanation of the nature of disease and possible treatment options in order to help patients make the best decision.
Almost all bed in our hospital is in a private room (this is very rare in Japan), so that patients can consult with doctors in a private environment and also spend their time with families comfortably during their stay. Our goal is to provide the best care to our patients. We are committed to try to provide "world standard" care utilizing every knowledge and techniques that we possess. We promise to fulfill the needs of our patients to the best of our abilities, so that patients can feel that it was worth receiving treatment at our hospital.
Patients who would like see doctors in our department are advised to make an appointment ahead of time with reference letter from family doctors. Direct contact to our department without referral is also possible.
When do you need to visit our department?
Our department treats benign and malignant surgical diseases of the lungs, trachea, bronchi, mediastinum, thymus, chest wall, the diaphragm and other structures within the chest. Treatment for the heart, great vessels, breasts or the esophagus are excluded and dealt by other departments. In most cases, patients usually see family doctors first and are then referred to our service.
We also accept patients without a definite diagnosis: for example, patients who are noted as having an "irregularly shaped shadow on the x-ray", an "irregular shadow on the chest CT scan during a medical checkup" or an "irregular shadow on the chest wall and mediastinum." We propose the best integrated diagnostic and treatment plan to each patient in collaboration with specialists in pulmonary medicine and radiology. For patients who are found to have an irregular shadow in chest images from a medical checkup or cancer screening test, we suggest visiting a certified physician in thoracic surgery or pulmonary medicine as soon as possible.
Thoracic Diseases and our Treatment
Lung Cancer
Video Assisted Thoracoscopic Surgery (VATS) for early stage lung cancer
- Compared to traditional open thoracotomy, this procedure leaves smaller scars and less pain after surgery.
Extended surgery to locally advanced lung cancer
- For locally advanced lung cancer, we will aim for radical resection. We are also able to treat lung cancer which has infiltrated other organs, by cooperation with specialists in other fields.
Limited resection for patients with poor pulmonary function
- We perform resection even for patients with marginal lung function, such as COPD, to achieve the best possibility of cure.
Multimodal therapy for lung cancer
- We collaborate together with specialists in radiation oncology, pulmonary medicine and palliative care to discuss the best possible treatment patients for patients with thoracic malignancies. We can propose a tailor-made combination therapy including surgical operation, chemotherapy, radiation treatment, immunotherapy.
- We provide seamless transition across the specialty from the first visit to the first treatment.
Bronchoscopy approach and CT guided needle biopsy in diagnosis and staging of lung cancer. Hilar and Mediastinum lymph needle biopsy by special endoscope (EBUS-TBNA: Endobronchial ultrasound-guided transbronchial needle aspiration). Mediastinoscopy and thoracoscopy for lymph node tissue biopsy.
- A minimally invasive biopsy is useful for determining the appropriate treatment. These biopsy measures could also avoid the unnecessary surgery for patients who should be best treated with non-surgical therapy.
- Diagnosis and stating using these devices is important for appropriate treatment, and our strength is that we can do all the diagnostic methods necessary for standard lung cancer diagnosis and staging.
Second opinion of outpatient
- We think that treatment of lung cancer should be tailored to each patient. Recently, treatment options are increasing by year, and occasionally opinions may vary from doctor to doctor. As a patient, listening to the opinions of multiple doctors may be useful for decision making. So we opened a consultation clinic for such patients. Patients can have counselling on surgical treatment of lung cancer and surgical treatment of mediastinal tumors.
Mediastinal tumor, Mediastinal cystic lesions, Mediastinal lymphadenopathy
A minimally invasive thoracoscopic surgery, median sternotomy, extended surgery.
- The mediastinum refers to the area surrounded by the left and right lungs and the area around the heart. The most common type of tumors in the mediastinum are a "Thymoma," which is sometimes deemed benign even by physicians and left untreated. However, it is a malignant tumor that can infiltrate and sometimes metastasize to other organs. Furthermore, surgery is preferred treatment method because thymomas can be often cured by resection. Sometimes it is difficult to distinguish thymomas from benign cystic lesions using only radiological images. For this reason, surgery may be performed for the purpose of both diagnosis and treatment for mediastinal diseases with cysts. Minimally invasive surgery with a thoracoscope can be employed in this situation.
- We opened the second opinion outpatient consultation in November, 2018.
Robotic-assisted thoracoscopic surgery
Robotic-assisted thoracoscopic surgery
- Robotic-assisted thoracoscopic surgery is a new minimally invasive operation using a 3D high-resolution camera and robotic arms that can transfer surgeon's movement into precise actions. A machine called Da Vinci is the only approved robot for surgery that can be used in Japan as of November 2018.
- From April 2018, robot assisted surgery in thoracoscopic lobectomy and mediastinal lesions became covered by insurance. However, in reality, the number of robot is still limited. Moreover, hospital that performs thoracic surgery using Da Vinci are quite limited in Japan.
- At our hospital, Dr. Hashimoto, the chief of department, is qualified to perform surgery using Da Vinci, and he also has actual surgical experiences while studying in Toronto General Hospital, Canada. From October 2018, we started robot assisted thoracoscopic surgery in our hospital. In the future, we can offer this surgery to patients. Although facilities that can perform robotic assisted thoracoscopic surgery is expected to increase in number in the future, as of now November 2018, only Ashikaga Red Cross Hospital can provide this operation in Tochigi Prefecture · Ryomo region · Gunma Prefecture.
We would like to continue offering robot assisted thoracoscopic surgery using the cutting-edge equipment to the local community in order to be a source of power to patients with chest tumors. We also accept patients outside the city and prefecture so that many patients can have access to and benefit from this robot surgery system. All of our hospital rooms are private rooms (most of them are free private rooms), and we believe we can provide comfortable circumstances for the patients and their accompanied families coming from other lesions.
Metastatic lung tumor
Thoracoscopic surgery, radical resection via Thoracotomy
- In general, we perform surgery for metastatic lung tumors only when the primary lesion is under control, the tumor is metastasized to the lung only, and all target lesions are safely resectable. Lung metastasis commonly occurs in gastrointestinal cancers, gynecologic cancers, head and neck cancers, and soft tissue sarcomas. If there is only one nodule in the lung, it may be a primary lung cancer for which a different diagnostic and treatment plan needs to be considered. When pulmonary nodule(s) are pointed out after treatment for these cancers from non-pulmonary origin, please consider consultation with our department together with the department that treated the primary cancer before.
- We also accept consultation from other hospitals.
Myasthenia gravis (MG)
Thoracoscopic thymectomy
- For some patients with myasthenia gravis, it has been proven that surgical resection of the thymus provides better symptom relief compared to medical treatment alone. Even though the median sternotomy is a standard approach, using a Thoracoscope or Robotic-assisted surgery for thymectomy from small wounds is possible when patients hope to do so.
Pneumothorax
Thoracoscopic surgery, conservative treatment
- We first perform non-surgical therapy using chest tube drainage, and then suggest a minimally invasive operation using a thoracoscope if needed.
- It is a disease that can happen to young people and women, not to mention safety, we also will try to make that to wound is not as noticeable.
Chest wall tumor
Chest wall resection, chest wall reconstruction
- If indicated, we perform a radical resection for large tumors by incorporating a reconstructive procedure.
Infectious diseases of lungs
Pulmonary non-tuberculosis mycobacteriosis (lung NTM disease), Surgical therapy for mycoses
- NTM lung disease is rapidly becoming more common. This disease is first managed by an internal medicine physician using antibiotics. Surgery is considered in the following cases: the drug is ineffective, the patient has hemoptysis, or there is a significant cavity or bronchiectasis.
Tracheal tumor, Tracheal stricture, Tracheobronchial malacia, Foreign body in the airway
Radical surgery therapy, interventional therapeutic using flexible and rigid bronchoscope, insertion of airway stents
- Surgical treatment of the respiratory tract is uncommon and requires expertise that we possess. These conditions could lead to "dyspnea" and may require urgent treatment.
Tracheostomy and its complications
Percutaneous tracheotomy, Surgical tracheotomy, Fistula closure, Treatment for post intubation/tracheostomy tracheal stenosis
- When indicated, we can perform tracheotomy. We can handle any post-tracheostomy issues, such as tracheal stenosis or remaining fistula.
Chest wall deformity （pectus excavatum, pectus carinatum）
Operative treatment (Nuss procedure, Ravitch procedure)
- This is a method of surgically correcting the shape of the anterior chest wall. If you have any concern with the shape of chest wall, please contact us.
Palmar hyperhidrosis
Thoracoscopic sympathetic nervous system clipping
- By blocking part of the nerve in the chest, it is possible to suppress excess sweating of the hand. It is a thoracoscopic surgery performed from small incisions of about 5 mm, and the wound is not conspicuous.
Empyema
TSurgical/non-surgical therapy (percutaneous drainage)
- For empyema (infection in the chest cavity), non-surgical treatment is attempted first, but surgical treatment may be necessary. Treatment with thoracoscopic surgery is also performed.
Malignant pleural effusion
Palliative care by pleurodesis
- As fluid accumulates in the chest cavity due to cancer, the lungs are compressed. This can make you feel difficulty breathing. Drainage of pleural effusion is attempted first for this situation. For recurrent accumulation, pleurodesis is performed to artificially make adhesion in the chest and avoid re-accumulation of fluid. It aims to alleviate symptoms of respiratory distress.
Unexplained pleural effusion
Diagnostic by thoracoscopic needle biopsy
- When patients have pleural effusion with unknown cause even after a thorough evaluation by physician, we can provide thoracoscopic surgery to take biopsies that is known to raises the probability of finding out the cause of effusion.
Malignant pleural mesothelioma
Thoracoscopic diagnostic procedures, Multimodality therapy including surgery
- Malignant mesothelioma is a malignant tumor arising from mesothelium covering the chest cavity. Multimodal therapy is required.
Giant lung cyst, COPD
Thoracoscopic resection、lung volume reduction surgery
- If respiratory distress is not improved even by a conservative approach such as inhaled medication and rehabilitation, surgical operation is considered after evaluation in detail of the respiratory function. Surgery from a small incision using a thoracoscope is also possible.