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Preoperative Patient with Pectus Excavatum
Postoperative Patient showing minimally invasive Pectus Excavatum repair bandages
The latest preoperative imagining techniques allows thoracic surgeons to plan the removal of a pulmonary sequestration
Thoracoscopic view of the inside of the chest after sympathectomy for hyperhidrosis

Thoracic Surgery

The Johns Hopkins All Children’s pediatric surgery group has a special focus on congenital and acquired conditions of the neonatal and pediatric chest.   Notable aspects of the program include:

  • The first minimally invasive repair of a congenital diaphragmatic hernia in the region was performed at All Children’s Hospital.
  • The first comprehensive pectus excavatum treatment center in the region was started at All Children’s Hospital.
  • Johns Hopkins All Children’s surgeons perform more pediatric thoracic procedures than any other pediatric hospital in the region.

The discipline of thoracic surgery encompasses operations of the chest wall and the organs contained within (excluding heart surgery).  The various conditions treated by our thoracic surgeons are classified as congenital anomalies, acquired conditions, tumors of the chest , and deformities of the chest wall (like pectus excavatum).  

The chest with the small incisions hidden under the arm at the completion of a minimally invasive repair of a pectus excavatum.

Pectus Excavatum

Anomalies of the chest wall, including pectus excavatum and pectus carinatum, pose a challenge to thoracic surgeons.  Older methods of repair required a major reconstruction of the chest through a large incision.  Over the past 20 years a minimally invasive approach has evolved which allows correction of the defect through small incisions thereby minimizing pain and scarring for the patient.   The Johns Hopkins All Children’s approach to the pectus patient emphasizes preoperative preparation and counseling.  Patients undergo evaluation by a cardiologist (heart specialist) and a pulmonologist (lung doctor) as well as specialized imaging tests designed minimizing radiation exposure to a child.  Once this thorough preoperative evaluation is completed, the combined experience of Dr. Nicole Chandler, who was previously at the Johns Hopkins Hospital, one of the busiest pectus excavatum centers in the country, and Dr. Paul Danielson, who originally learned the minimally invasive pectus repair from its developer, Dr. Donald Nuss, is used to devise the best treatment plan for each individual patient.  Get more information about pectus excavatum, or watch a video of a minimally invasive pectus excavatum repair surgery.

Congenital Conditions

A multidisciplinary team of perinatologists, neonatologists, pediatric anesthesiologists and pediatric surgeons manage complex congenital lesions of the chest.  Many of these are identified prenatally allowing our team to begin management of the condition even before the baby is born.  However, even in situations where these problems are not discovered until after birth, Johns Hopkins All Children’s Hospital is the major referral center for neonatal surgery on the west coast of Florida.  Managing so many babies with complex chest problems means an experienced operating room and intensive care unit team is always prepared.  Examples of congenital anomalies typically handled include:

  • tracheo-esophageal fistula
  • diaphragmatic hernia
  • pulmonary sequestrations of the lung
  • congenital cystic adenomatoid malformations of the lung
  • bronchogenic cysts
  • congenital lobar emphysema
  • esophageal duplications

Acquired Conditions

Infections of the lung (pneumonia) or of the area around the lung (empyema) will sometimes require the intervention of a surgeon.  Working closely with the pediatric infectious disease specialists at Johns Hopkins All Children’s Hospital, our surgical group has devised a comprehensive treatment algorithm based on the latest scientific evidence to ensure that every child with a chest infection gets the best treatment.  Similarly, the management of pneumothorax and chest trauma continues to evolve, and our group utilizes the latest minimally invasive techniques to address these conditions (watch a video of a thoracoscopic operation to treat recurrent pneumothorax).

When most people think about the chest, the heart and lungs come immediately to mind.  However, it is the foregut (i.e. the esophagus) that is the organ that often requires the expertise of a thoracic surgeon.  For example, gastroesophageal reflux  — what many would call heartburn — is not just a disease of adults.  Little babies, children and adolescents also suffer from this and operations to prevent harmful reflux are commonly performed by pediatric surgeons using special tiny scopes and small incisions.

Some children and adolescents suffer from excessive sweating in their palms and armpits called hyperhidrosis.  The surgeons at Johns Hopkins All Children’s Hospital were the first to bring to the west coast of Florida the minimally invasive surgical technique for treating this debilitating condition in children.  By going into the chest with a miniature scope and two additional small holes, a sympathectomy can be performed to eliminate the problem (watch a video of a sympathectomy).

Tumors of the Chest

Many different types of tumors can arise in the chest in the pediatric age group.  Some of these are benign while others are malignant (cancerous).  The thoracic surgeons are part of the multidisciplinary pediatric team that is assembled to care for these special patients.  Our pediatric radiologists use the latest technology to perform ultrasounds, MRIs and CT scans on these patients and in some cases can even perform biopsies (obtain a sample of the tumor for testing) under imaging guidance.  Some patients require an operation to diagnose, treat or remove tumors of the chest, and our pediatric surgery team is experienced in operating on all the various chest tumors including neuroblastomas, lymphomas, thymic tumors, teratomas among others.  And just as with other conditions, minimally invasive techniques are used whenever possible when dealing with tumors.

Appointments and More Information

For more information, visit Pediatric General Surgery. To make an appointment or to ask questions, please call 727-767-4170.