Chest Wall Tumours, Reconstruction and Deformities: A Minimally Invasive Approach

A large number of patients from various African countries have been treated, most commonly for bronchiectasis and various tumours of the lung and chest cavity, even without ever having personally visited Africa. For heart transplantation specifically, deceased-donor transplant is not possible for international patients under Indian law, so the more common referral for advanced heart failure from abroad is for an LVAD (left ventricular assist device), which has very good outcomes and has itself reduced overall demand for heart transplant.

Deceased-donor lung transplantation is not possible for international patients in India under current law, but in general, outcomes vary significantly by the underlying pathology, results are good for pulmonary hypertension, while outcomes for cystic fibrosis, bronchiectasis and other conditions vary by the individual disease process rather than following one single success rate.

After empyema surgery in young patients, both a visceral and parietal decortication are performed, and dense adhesions do form afterward, that is simply the nature of the disease and the aim of surgery is to release the lung and prevent fibrothorax, not to avoid adhesions altogether. Lung transplantation after pulmonary tuberculosis is very challenging, particularly if the patient has already developed fibrothorax; a unilateral transplant may be possible in some cases, but it depends entirely on the individual patient and no generalised statement can be made. Deceased-donor lung transplant is also not available to international patients under Indian law, which permits only living donors.

The robotic platform's vision is excellent, so nerves that are difficult to identify by standard VATS are very clearly seen with the robotic system, and it also allows much finer dissection. These sensitive structures are therefore better identified and better protected specifically because of the robotic system's magnified 3D vision and precise instrument control.

Surgery should never be offered to every patient with hyperhidrosis; a detailed assessment is required first, and all non-surgical options, oral medication, local treatment, creams, and Botox, should be exhausted first. Surgery is reserved only for high-grade hyperhidrosis where the hands are literally dripping, since every form of surgery carries some side effects, and the benefit of dry hands has to be weighed against them. Patient selection and precise technique matter more than the surgery itself: robotic assistance allows accurate identification of the ganglia, which is very difficult by standard VATS, and Dr. Khandelwal's own technique of setting the sympathetic chain close to the third ganglion with a grey ramicotomy at that level has produced good results with fewer side effects than older, less precise approaches.

A robotic approach from inside the chest allows segmental rib resection without dividing the scapular muscles, with the specimen removed through a small muscle-sparing thoracotomy, avoiding the large traditional incision and its associated pain and deformity.

Plate fixation meaningfully reduces the need for pain medication after injury and helps prevent chronic chest pain and future chest wall deformity, expanding the indication beyond only flail-segment fractures requiring ventilator support.