Thoracic Surgery Frederic W' Grannis Jr' MD

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Thoracic SurgeryFrederic W. Grannis Jr. MD

• A lecture to students at the
• Western University of Health Sciences
• Pomona CA December 17, 2002

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Thoracic Surgery

• Cardiac Surgery
• Acquired
• Congenital
• Vascular Surgery
• aneurysms
• aortic dissection
• Esophageal Surgery

• General Thoracic Surgery
• Pulmonary
• Chest Wall
• Mediastinal
• Pleural
• Pericardial
• Neural

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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

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Stop at the Pleura! A Brief History of Thoracic
Surgery

• Frederic W. Grannis Jr. MD
• City of Hope National Medical Center, Duarte,
  California

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H. M. Block

• Experimenteles zur Lungenresection
• von Dr. Block (Danzig)
• Deutsche Medizinische Wochenschrift
• 7634-6, 1881

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Letter from Berlin Resection of the Lung as
Proposed by Dr. Block

• G.L. Walton. Boston Medical and Surgical Journal,
  Vol CVII261-262. February 23, 1883

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Bronchoscopy
1898

• Gustav Killian

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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.

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Ludolph Breuer
1904

• Uberdruck

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Ferdinand Sauerbruch

• Unterdruck

1904
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Early Endotracheal Tubes

• Chausier

Ribemont
Gairal
Geudel
1928
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Endotracheal Intubation
Whelan
Doyen
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FellODwyer
1898
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• Meltzer and Auer

New York 1909
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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.

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Evarts Graham

• Pneumonectomy
• 1932

Cautery Pneumectomy
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Lothar Heidenhain

• First resection of a lung cancer
• 1903
• (incidental in lobectomy for bronchiectasis)

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Davies

• First anatomic dissection c. 1912

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Pleurodesis

• v. Mickulykz

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Tourniquets
Shenstone
Roberts
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Bulau
1873
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Pulmonary Resectioncirca 1930
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• 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
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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.

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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