Diagnosing and Treating Mediastinal Masses: EBUS, Mediastinoscopy and Thymectomy

Technology has made the world smaller, so practically everyone is living next door to expertise now. Any case can be raised by email or WhatsApp, with a response guaranteed within 24 hours, and the case can often be investigated or even treated locally with guidance if the necessary technology and facilities are available there. When the expertise or facilities are genuinely not available locally, the patient can then be brought to India, but sharing the case first, even just to check whether it meets the threshold for referral, is always the right first step.

Surgery isn't just about surgeon skill, it also depends on OT infrastructure and trained technical staff, and not everything required can be exported to run a camp abroad. A more practical model already in use is a structured online OPD: patient details and reports are shared in advance on an agreed schedule, and the African doctor partner, the Jivo team, and the Indian specialist jointly review the case and decide what can be treated locally versus what genuinely needs travel to India, with real patient satisfaction from this approach so far.

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.

EBUS (endobronchial ultrasound). If it is inconclusive, a VATS mediastinal lymph node biopsy or video mediastinoscopy can sample or remove the nodes for a definitive pathology diagnosis.

A robotic technique entering below the sternum through the subxiphoid space, which visualises both phrenic nerves and the neck simultaneously, enhancing the radicality and safety of thymectomy compared to older approaches.