Thoracic Emergencies: Chylothorax with ICG Guidance and Boerhaave Syndrome

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.

Devices like Novalung or ECMO are sometimes loosely called artificial lungs, but these are only a transition to tide a patient over, not a permanent solution. Xenotransplantation for lungs is not a reality and is still limited to animal labs, with no near-term prospect of harvesting an animal lung for human transplantation. What is genuinely advancing is ex vivo lung perfusion (EVLP), where a harvested lung is brought to a lab and optimised before transplant, this has meaningfully increased organ utilisation and allows transplant surgery to be done electively rather than only at odd hours, though it remains expensive even in Western countries.

By injecting indocyanine green (ICG) dye into the inguinal lymph nodes pre-operatively; under the robotic camera's infrared light, the dye highlights the thoracic duct clearly enough to localise and ligate it precisely, even in dense inflammatory tissue.

Spontaneous oesophageal rupture from forceful retching or coughing, typically at the lower oesophagus on the left side, which can present as empyema. It is managed with endoscopy and stenting to control the leak first, followed by drainage and debridement of the mediastinal collection.