Surgical Procedures & Innovations

At NewYork-Presbyterian Hospital/Columbia University Medical Center, our physicians develop and implement the most advanced thoracic surgery procedures available. These new procedures are changing the face of thoracic care—advancing surgical efficacy while improving patient comfort. To learn more about specific thoracic procedures and innovations currently performed at NewYork-Presbyterian/Columbia, click on the links below. For more information on the diseases that these procedures treat, click on the Thoracic Diseases link in the navigation bar on the left.

Minimal Access Surgery

Utilizing smaller incisions, minimal access surgery reduces pain and recovery time for patients. At NewYork-Presbyterian/Columbia, we offer minimal access alternatives for a range of thoracic diseases and disorders, including: lung cancer, melanoma, hyperhidrosis, and thoracic outlet syndrome. We also offer thoracoscopic procedures, which utilizes small incisions and cameras, to help diagnose and treat interstitial lung disease, lung cancer, pulmonary nodules, and spontaneous pneumothorax.

Minimally invasive surgery in the chest, referred to as video-assisted thoracic surgery (VATS), is being used for both diagnostic and therapeutic interventions for a number of chest problems that previously required large, open surgical incisions.

Image-Guided Thoracic Surgery

Image-guided technology utilizes advanced imaging techniques to construct a 3D image of the patient's anatomy. The image is used in the planning of surgery, or during surgery as a real-time 3D anatomical map. Facilitating precise viewing of tissues and structures in the lungs and mediastinum, imageguided techniques promote high precision and minimal invasiveness in surgery, and may facilitate non-surgical approaches. The technology is especially appropriate for patients who would otherwise be unable to tolerate an invasive operation.

Lung Disorders

Lung Resection refers to the removal of a portion of the lung (lobectomy) or the whole lung (pneumonectomy) in patients with lung cancer, emphysema or other lung disorders. The procedure involves either an incision in the chest (open surgery), or a minimal access approach to remove the diseased area of the lung.

Lung transplantation offers a return to improved breathing and an excellent quality of life for patients suffering from advanced emphysema, pulmonary fibrosis, cystic fibrosis, pulmonary hypertension, or other debilitating respiratory disorders. NewYork-Presbyterian/Columbia is a leading center in the field of lung transplantation. In each of the last three years, more lung transplants were performed here than at any other transplant hospital in the tristate region. Medicare-approved as a center of excellence in lung transplantation, our outcomes are a testament to our expertise—with one-year survival following double-lung transplant exceeds 90%. This is far superior to the results of many highly regarded transplant programs in the country.

Surgery for Emphysema: NewYork-Presbyterian/Columbia is the only medical center in the tri-state area designated by the National Institutes of Health (NIH) as a center of excellence in Lung Volume Reduction Surgery (LVRS) for the treatment of emphysema. The LVRS procedure involves the removal of sections of damaged lung tissue. This surgery can be performed through either median sternotomy (open chest) or video-assisted minimally invasive technique. By removing the most diseased tissue (up to 30% of the lung volume), the goal is to improve the residual lung function and respiratory mechanics.

We recently participated in a NIH sponsored, seven-year prospective randomized NETT trial that confirmed that LVRS significantly improves survival and quality of life in carefully selected patients with emphysema. Since not all patients with advanced emphysema are candidates for LVRS, we are participating in the multi-institutional VENT to test a new investigational device that is broncoscopically inserted into the bronchus or airway of the lung. This minimally invasive procedure may improve patients' exercise capacity, breathing, and quality of life, without the need for surgery.

A non-surgical approach, pulmonary rehabilitation has clear benefits for patients with chronic obstructive pulmonary disease (COPD). The comprehensive program includes exercise training in endurance and strength, education, nutrition counseling, and support / counseling services.

Esophageal Disorders

Esophageal Cancer: As with lung cancer, a multidisciplinary approach is used to evaluate and treat patients with esophageal carcinoma. Working closely with our colleagues from interventional gastroenterology, patients with precancerous changes, also known as Barrett's disease, may be candidates for Photodynamic Therapy (PDT) or Endoscopic Mucosal Resection (EMR). For those patients requiring esophageal resection, our surgeons are pioneering new techniques in esophageal cancer surgery, such as roboticassisted minimally invasive esophagectomy. This procedure allows a more rapid recovery, with reduced incisional pain compared to standard open surgery.

GERD: For those patients in whom a medical regimen has not been successful, anti-reflux surgery, employing a variety of fundoplication and plication procedures, can offer gratifying, durable results with relief of GERD. Fundoplication involves gathering and sewing the very top portion of the stomach around the lower end of the esophagus and the esophageal sphincter. In appropriately selected patients, minimally invasive surgical techniques have significantly reduced hospitalization days and convalescence.

Hyperhidrosis (excessive sweating)

Endoscopic Thoracic Sympathectomy (ETS) is a minimally invasive procedure that eliminates hyperhidrosis. The operation is performed on the sympathetic nerve through two microscopic incisions in the armpit. Most patients return home within hours and report immediate results with reduced side effects.

Bronchial Disorders

The Interventional Bronchoscopy program draws on the full resources of NewYork-Presbyterian/Columbia. This innovative approach to diagnostic and therapeutic care for such problems as endobronchial tumors or tracheobronchial obstructions offers patients substantial expertise from the divisions of thoracic surgery and pulmonary medicine at Columbia.

Photodynamic Therapy (PDT) is a unique method for treating cancers growing in the trachea and bronchial air passages. This treatment consists of injection of a photosensitizer (Photofrin®) followed by illumination of the cancer through a fiberoptic bronchoscope. This illumination process destroys tumor cells in select cancers.

Tracheal Surgery

Because the blood supply to the trachea is limited and difficult to predict, tracheal surgery is not a straightforward procedure and requires specific surgical training and experience. Several of our surgeons are specially trained in surgery for the management of tracheal stenosis, which is often caused by tracheal tumors, benign strictures, and inflammation due to breathing tubes.

Mesothelioma

NewYork-Presbyterian/Columbia has been designated a center of excellence in the management of mesothelioma by the National Cancer Institute of the National Institutes of Health. We are currently studying several new treatments, including a novel multimodality, or combination approach, which includes vaccine therapy, in vitro chemosensitivity testing, and drug analysis, followed by surgical removal and radiotherapy. A multimodality approach to this disease offers patients the best chance to be cured.

Myasthenia Gravis

For well over 50 years, New York-Presbyterian / Columbia has been internationally recognized as a leader in the diagnosis and treatment of myasthenia gravis. Our current research efforts are directed towards the development of a more standardized staging system to allow comparison of different medical and surgical therapies, including robotically assisted minimally invasive thymectomy (removal of the thymus gland). Our multidisciplinary team approach—including experts from neurology, pain management, pulmonology, and critical care—has dramatically improved the effectiveness and safety of thymectomy, which can now be recommended even for patients with advanced muscle weakness.