Surgery

THORACIC SURGERY

Staging and diagnostic

• Mediastinoscopy, re-mediastinoscopy, anterior mediastinoscopy, thoracoscopy (VATS)

Treatment 

• Primary lungtumors, lungmetastases, infections en congenitale disorders of the lung: wedge excision, lobectomy, sleeve lobectomy, pneumonectomy (intra-en extrapericardial) or sleeve pneumonectomy.

• Primairy lung tumors (stage I and II) are resected with VATS lobectomy since 2010 (no ribspreading)

• Thoracic wall

• Congenital thoracic wall disorders (pectus carinatum, pectus excavatum, hernia diafragmatica,...) by open techniques or by thoracoscopic techniques (Nuss-procedure; MIRPE)

• Traumatic

• Tumors by resection and reconstruction including pancoast tumors

• Mediastinal tumors (thymus, neurogenic tumors, germ cell tumors, soft tissue tumors, ...) by open techniques or thoracoscopy (Da Vinci Robot)

• Malignant mesothelioma: thoracoscopy / extrapericardial pneumonectomy

• Pneumothorax (primary, secondary, recurrences, traumatic): thoracoscopic or open

• Emphysema: open or thoracoscopic techniques (resection of blebs, bullae, giant bullae, LVRS)

Specific

• Isolated lung perfusion for lung metastases (Faze II study)

• Trachea surgery: alle interventions of the trachea with exception of a tracheotomy are performed in close collaboration with the ENT-department

• Lung Transplantation for end-stage pulmonary disease

VASCULAR

Non-invasive diagnostics

• Doppler ultrasound (arms, legs)

• Duplex ultrasound (arterial + venous)

• Threadmill testing (walking distance)

Open Vascular Surgery

   Arterial

• Operations at the level of the supra-aortic vessels = carotid, carotido-carotid bypass, carotido-subclavian bypass, glomustumors

• Operations at the level of the thoracic and abdominal aorta = aortic dissection (type B), aneurysms of the total aorta starting from the level of the subclavian artery untill the femoral arteries, disorders of the visceral vessels, renal arteries, en interventions for infected prostheses (donor arteries, deep vein reconstruction, ...).

• Placement of endoprostheses (EVAR, TEVAR) is done since 2011 percutaneously (no incision) and whenever possible under local anesthesia (2-day clinic)

• Operations of the iliac arteries (pelvis) and arteries of the limbs (legs/arms) for occlusive disease or aneurysmatic disease: techniques are iliofemoral bypass, axillo-(bi)-femoral bypass, femoro-femoral bypass, endarteriëctomie, ringstripper + endolining, femoro-popliteal bypass, femoro-distal bypass, obturatorbypass.

• Functional surgery: neurostimulation and sympatectomy

• Amputations of arms / legs (for end-stage vascular disease)

• Operations for trauma of the vessels

• Woundcare (newest topical dressings, debridement, skingraft, VAC-therapy, therapy with maggots, caisson, Bioptron lamp, reconstructions in collaboration with the service for plastic and resconstructive surgery)

   Venous

• Foam sclerotherapy (outpatient clinic or under general surgery in one-day hospital depending on the indication)

• Crossectomy

• Sclerotherapy

• TCC

• RFA

Laparoscopy / Thoracoscopy

• Surgery at the level of the infrarenal aorta (with the Robot Da Vinci system)

• Sympatectomy at thoracic or abdominal leel for end-stage vascular disease of for hyperhydrosis (axillae, palms, feet, ...)

Endovascular

• Treatment of all arteries except for the coronaries and intracranial arteries: carotid, renal arteries, subclavian artery and branches, descending aorta and abdominal aorta, iliac arteries, femoral arteries, BTK) by PTA (balloon angioplasty and/or stenting).

• Treatment of aneurysms (descendings aorta, abdominal aorta, iliac artery, popliteal artery) with covered stents of endoprostheses (NATIONAL CERTIFICATION FOR BOTH ABDOMINAL AND THORACIC AORTA). These endoprostheses are placed by percuteneous route and under local anesthesia whenever possible.

• Treatment of all venous vessels of the body but mainly iliofemoral and vena cava for stenoses / trombosis (recanalisation; stents; cava filters)