Dr. Michael Koury performs thoracic surgery on a patient at Baptist.

Baptist Now State’s First Facility with Comprehensive Thoracic Surgery Clinic

Baptist Medical Center in Jackson recently became the first facility in Mississippi to offer a comprehensive thoracic surgery clinic that provides a full complement of surgical procedures for chest diseases.

Thoracic surgeons at Baptist Medical Clinics, a division of Baptist, are implementing some of the most advanced minimally invasive and complex thoracic procedures, such as the specialized technique for pectus excavatum. Also known as a sunken chest, pectus excavatum is a congenital chest wall deformity—a malformation in which the ribs and chest wall appear indented or sunken toward the spine—that affects one in 1,000 children, predominantly male.  

Michael Koury, MD, director of the Thoracic Surgery Center at Baptist, performed the first pectus excavatum procedure in Mississippi several years ago, using the touted Nuss procedure. Many such procedures have been done since then. Developed by Virginia pediatric surgeon Donald Nuss, MD, in 1987, the Nuss procedure remains the preferred method for correction of pectus excavatum.

The Nuss procedure, which takes an hour or less to complete, calls for a small incision on each side of the rib cage. Next, a curved, custom-shaped, stainless steel bar is woven through the rib cage beneath the sternum. Once in place, the bar is rotated, turning the curved portion against the chest wall, and therefore pushing out the ribs and chest.

The bar is secured to the chest wall with sutures and left in place for approximately two years. Among other benefits, the procedure requires smaller incisions and leaves only two small scars. The traditional open procedure takes longer and typically involves more blood loss.

“We know that even in adults, the chest wall will change shape, but much more so in children,” explained Koury, who learned the procedure directly from Nuss. “So when this bar is used in children whose chests are still forming, the effects are very good. The bar acts as an internal brace and the deformity is corrected immediately. By keeping the bar in place for two years, the chest wall should remain stable for a lifetime. It’s very analogous to braces on teeth.”

Thoracoscopic sympathectomy for sweaty palms, also known as hyperhidrosis, represents another minimally invasive procedure performed first statewide at Baptist. Palmer hyperhidrosis—severe sweating of the hands and axilla—affects 1 percent of the population. This embarrassing condition adversely affects a person’s ability to function in social, school or work environments.

Not long ago, major surgery was required for patients with palmer and/or axillary hyperhidrosis, during which a thoracic surgeon provides a permanent cure for the excessive sweating via clipping or dividing the sympathetic nerves that control sweat glands.

To perform a thoracic sympathectomy thoracoscopically, Koury makes two 5-millimeter incisions beneath the patient’s axilla. The lung is permitted to fall away from the inside of the rib cage and a camera is inserted into the chest cavity. The lung is pushed aside to identify the sympathetic chain. The camera provides magnification, so structures appear larger and in greater detail. Using a cautery device, the correct levels for the patient’s symptoms in the sympathetic chain are divided. The incisions are closed and an identical operation is performed on the patient’s other side. Scarring is minimized by using this technique.

“It used to be a much more involved surgery,” said Koury. “Now it’s done on an outpatient basis and is about 98 percent successful. These are my most grateful patients because they’re able to lead a normal life.”

For several years, Koury has been involved in video-assisted thoracic surgery, also known as VATS, and uses it extensively for diseases of the lung and chest wall lining, and also effusions in the chest. Using a video camera and thoracoscopic instruments, Koury can biopsy abnormalities of the lung, clean up empyemas, take care of collapsed lungs from bleb disease, and many other abnormalities in the chest. Patients usually only require a two- to three-day stay in the hospital.

Recently, VATS procedures have been increasingly used for more complex procedures in the chest. For example, Koury has started using it for major lung cancer resections that have traditionally been done with a larger thoracotomy incision. Using VATS for pulmonary lobectomies requires three small incisions that avoid spreading of the ribs, from which most of the discomfort from thoracotomies arises. Using smaller incisions and a video camera for visualization, a lobectomy and lymph node dissection is able to be done on par and with the same outcomes as a thoracotomy, but with less discomfort for the patient, a shorter hospital stay, and an abbreviated recovery time.

“The Thoracic Surgery Center at Baptist also manages a vast majority of pulmonary or thoracic surgery problems, including malignant and benign diseases or abnormalities of the lung, esophagus, chest wall, medistinum and pleura,” noted Koury.

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