SURGERY UNIT

Chest and Vascular Surgery

Hôpital Sainte Musse, Hôpital de La Seyne sur Mer

Lead Consultant: Dr Bruno GUELFUCCI

 Medical Staff

• Dr SIMMONET Matthieu
  Head of Service; Vascular Surgery

• Dr POIMBOEUF Jean-Michel
  Vascular Surgery

• Dr SIMONET Gaëtan
  Vascular Surgery

• Dr BELLIEUD Monique
Vascular Medicine

• Dr GIAUFFRET Frédéric
Internal Medicine; Vascular Medicine

• Dr LAHLAH Hocine
Chest Surgery

• Dr PETKOVA-MARTEAU Boriana
Chest and Cardiovascular Surgery

CONSULTATIONS

Chest and Vascular Surgery  – Consultations, inpatient and outpatient care

 

• Vascular Surgery

 

Appointment booking:

 04 94 14 57 69 

Dr Jean-Michel POIMBOEUF: Monday and Friday morning (Sainte Musse)

Dr Matthieu SIMONNET: Monday morning (La Seyne sur Mer), Monday afternoon and Thursday afternoon (Sainte Musse)

Dr Gaëtan SIMONET: Tuesday and Thursday afternoon (Sainte Musse)

 

• Chest Surgery

 

Appointment booking:

 04 94 14 57 68 

Dr Hocine LAHLAH: Monday morning (La Seyne sur Mer), Wednesday afternoon (Sainte Musse)

Dr Boriana PETKOVA-MARTEAU: Monday morning and Friday afternoon (Sainte Musse)

 

• Internal Medicine/Vascular Medicine

 

Appointment booking:

 04 94 14 57 61

 

• Vascular Explorations: vascular doppler ultrasound, transcranial doppler ultrasound, threadmill tests, TCPO2 and pressure measurements.

 

Dr Frédéric GIAUFFRET: Everyday

Dr Fabien HOCQ: Thursday morning

 

• Wound and healing consultations:

 

Dr Monique BELLIEUD-GIAUFFRET: Monday afternoon

Dr Frédéric GIAUFFRET: Thursday afternoon

 

• Internal medicine consultations, capillaroscopy:

 

Dr Frédéric GIAUFFRET: Wednesday morning and Friday afternoon

• Patient Therapeutic Education Programme in cardiovascular diseases

For any information or wish to participate, please contact:

Mrs MP BEKHOUCHE

 06 95 93 53 60 

Dr Frédéric GIAUFFRET

 04 94 14 58 11

 

History

Chest and Vascular Surgery was first integrated at the end of the 80's in the multi-purpose surgery department of the C.H.I.T.S. In 1995, only two full-time practitioners and one casual worker were in charge of the activity. For the record, in 1994 about forty vascular restoration and as much lung cancer resections were performed at the C.H.I.T.S.

A growing demand of activity, encouraged by the collaboration with multiples specialities, led to the  structuring and individualising of a true Chest and Vascular surgery department in 1999. The first head of department was Dr Francis LANGLET, followed by Dr Roberto GULINO in 2008.

The activity of vascular surgery was strengthened by the creation of a non-invasive vascular exploration centre in 2003 in order to optimise the diagnostic and therapeutic care of patients suffering from arterial and venous diseases. In 2006, a vascular and internal medicine department was individualised at the instigation of Dr Frédéric GIAUFFRET in order to strengthened the medical side of the patients care.

Progressively, new chest and vascular surgeons were hired, allowing the building of a surgical team of 5 practitioners with specific skills and adapted to the challenges of the current therapeutic care of the Var area. Their activities are a part of the collaboration with the APHP of Marseille and various care networks. Currently, the department performs nearly  300 artieral surgery operations and a hundred of major lung resections annually.

The development on the Hôpital Sainte Musse in 2012 brought a new dimension to the discipline. Indeed, in addition to the modernity of the premises (hospitalisation services and operating theatres) and the equipment of high technological level, the name of the service was changed in order to highlight the global and medico-surgical nature of the patients care. Combining vascular surgery, vascular medicine and internal medicine, and thoracic surgery under the same entity and location, the service is now called: vascular and thoracic medico-surgical service. The arrival of interventional radiologists at the new facility brings additional expertise in the discipline for complex radio surgical procedures.

 

Chest Surgery

Pathways of approach

Chest Surgery can be performed with a classical surgical approach; either lateral (thoracotomy = approach between the ribs) or median (sternotomy = opening of the sternum). It has benefited from the contribution of the laparoscopic surgery (guided by means of an optic) and some operations are now performed by a less invasive approach, the thorascopy.

Pleural effusions surgery:

A Pneumothorax (air passage between the lung and the chest wall) is a frequent medical emergency: it usally only requires a thoracic drainage (drain) but a surgical symphysis of the  pleura is indicated in 10 to 20 % of cases (in case of a recurrent pneumothorax, bilateral pneumothorax, persistence of a bubbling of the drain after several days, pneumothorax associated with a pulmonary pathology). This procedure is mostly performed under thoracoscopy.

A pleurisy is characterised by the presence of fluid in the pleura (between the lung and the chest wall). In neoplastic effusions (of tumour origin), a thorascopic bipsy procedure is associated with pleural symphysis by poudrage. This procedure is often indicated because pleural metastases are common in numerous cancers and the number of primary pleura tumours is increasing (especially because of exposure to asbestos).

Diagnosis surgery

It allows the diagnosis of tumours and mediastinal and pulmonary pathologies. This also contributes to proceding to staging the bronchial cancers, so as to orientate the therapeutic protocol according to the TNM classification of the tumour. Indeed, the radiological examinations are not enough. An extemporaneaous anatomopathology examination (at the time of the procedure) is often indicated. Samples are made by mediastinoscopy and thoracoscopy. 

Tumour removal surgery

The surgical decision is taken during multidisciplinary consultation meetings (RCP - Réunions de concertation pluridisciplinaire in French) in order to coordinate care (surgery, chemotherapy, radiotherapy). The local extension of the tumour is not in itself a contraindication to curative removal surgery. Apart from the resections of the chest wall, the extension of tumours to the superior vena cava, or to the contiguous vascular nerve elements of the pulmonary apex (Pancoast Tobias) may be accessible to extensive surgery with prosthetic vessel replacement.

 

The sympathectomy

It is the sympathetic nerve surgery. Theses nerves are responsible for vessel tone and other functions such as sweating (see an excessive sweating in the hyperhidrosis). They are located along the spine, at the thoracic (for the upper limbs) or lombar (for the lower limbs) level. Thoracic sympathectomy is performed under thoracoscopy, making it  less invasive than conventional thoracotomy.

The main orientation and the pathologies treated in the departments are the following:

1. Bronchial malignant tumours removal surgery (primary orsecondary): lobectomy, segmentectomy, penumonectomy, atypical removal

2. Benign or malignant mediastinal tumours removal surgery: thymectomy, thymomectomy

3. Chest wall surgery

4. Diagnosis surgery : médiastinoscopie, mediastinotomy, pulmonary biopsy, pleural biospy

5. Pleural surgery : thoracoscopy, poudrage, pleurectomy

6. Pneumothorax surgery

7. Hyperhidrosis surgery (thoracic sympathectomy)

8. Thyroid gland surgery

9. Respiratory insufficiency functional surgery: surgical treatment of emphysema bubbles

10. Thoracic trauma care: costal fractures, penumothorax, post-traumatic hemothorax

11. Diaphram and hiatal hernia surgery

 

Vascular surgery

Vascular lesions are highlighted by vascular ultrasound doppler, CT angiogram and angio-MRI, arteriography and phlebography.

Conventional surgery consists in treating artery occlusions in two ways:

• either by unblocking the vessel: removing a clot (embolectomy) or cleaning it from an atheromatous plaque that has clogget it (endarterectoma)

• or by short-circuiting the segment of vessel blocked by a bypass between the upstream and downstream permeable arteries. This bypass can be performed using a patient's superficial vein, a synthetic tube (Dacron, Goretex), and sometimes an artery taken from another deceased patient (allograft).

Endovascular surgery:

It consists in treating the vessel from within by introducing thin tubes (catheters) in the arteries punctered remotely from the diseased site (percutaneous route from the groin or arm crease). Navigation in the vessel is performed under radiographic control. At the tip of the catheter is a balloon that is inflated to dilate a constricted area. In some cases, the procedure is supplemented by the placing of a metal spring (endoprosthesis or stent) to repair the vessel or prevent recurrence of constriction (stenosis).

Aneurysms and dissections surgery

Arteries can deform by dilating (aneurysm) or by tearing (dissection). The treatment is done :

• either by conventional surgery (bypass by replacing the sick area)

• or by endovascular technique (placing a covered endosprothesis similar to a bypass)

The current procedures are extremely variable from one disease to another but very often minimal invasive operations are suggested.

Local anaesthesia and endovascular procedures are favoured when possible.

While referring to international standards of care, specific care is offered à la carte according to the nature of the lesions presented and the observations made during the operation. It is thus possible to adapt by offering both endovascular and conventional surgical techniques if necessary.

Superficial venous surgery

It is offered in advanced forms in addition to medical care. It consists in removing the whole of a diseased vein (most often the large saphenous vein in the context of a stripping) or localized venous dilatations (as in recurrences that may occur despite a first surgical procedure). The care is usually performed in the ambulatory surgery unit over one day.

The main surgical operations performed in the department are:

1. In the lower limb arteries area: stent angioplasty, vascular recanalisation, endarterectomy, arterial bypass surgeries.

2. In the neck vessels area: endarterectomy, carotid arteries angioplasty

3. Endoprosthesis and classical aneurysm surgery, especially of the abdominal and thoracic aorta

4. Realisation of arteriovenous fistula for haemodialysis and treatment of complications

5. For surgery of superficial venous insufficiency of the lower limbs: stripping, phlebectomy

6. Repair of vascular trauma during accidents and all vascular emergencies

7. Diabetic foot surgery

8. Diagnosis and therapeutic care (by embolisation) of arteriovenous vascular malformations

 

Internal Medicine

Internal medicine gathers a vast field of activities, as much in its methods of practice as in the typology of diseases managed. The internal medicine specialist (internist) treats a wide range of adult conditions, taking into account the totality of the patient's problems. He or she usually intervenes in second or third intention, for expertise and recourse purposes. By ensuring the synthesis of complex or intertwined problems, integrating the multiplicity of pathologies, he or she often makes it possible to achieve savings by limiting the recourse to complementary examinations.

Internal medicine, in its special features, is a patient's medicine before being that of a disease. Internal medicine is a medical specialty of which the objective is to achieve:

• difficult diagnostic procedures, to specify the cause of general deterioration, chronic fatigue, prolonged fever, diffuse or atypical pain, unexplained clinical manifestations, unusual biological abnormalities ...
• the care of rare and complex diseases, particularly those of immune or inflammatory origin (such as Horton's disease, scleroderma, lupus, Gougerot Sjogren syndrome, etc.) or genetic diseases (such as rare diseases and orphan diseases.

 

Vascular Medicine

Vascular medicine is the medical discipline which intervenes in the prevention, diagnosis, the treatment and follow-up of patients suffering from peripheral arterial, venous, lymphatic and microcirculatory vascular diseases. The vascular practitioner exercises this expertise thanks to his specific training and the mastery of vascular functional explorations among which the doppler ultrasound holds a dominant place. These explorations are non harmful, have exceptional diagnosis performance, and are totally adapted to the diagnosis of peripheral vascular diseases. They are a natural extension of the clinical approach.

 

The vascular physician is therefore the practitioner of peripheral vascular diseases such as:

• Artheromatous disease and its complications such as lower limb arteriopathy, carotid stenosis and stroke

• Venous thromboembolic disease represented by venous thrombosis (phlebitis) and pulmonary embolism, as well as blood clotting problems.

• Abnormalities in the microcirculation of the extremities of the limbs, of which Raynaud's phenomenon is the most common expression

• Vascular ulcers of lower limbs, complication of venous insufficiency, which causes chronic disabling wounds.

The vascular physician works closely with vascular surgery as well as medical specialties such as cardiology, neurology, nephrology, diabetology and internal medicine.

Patient therapeutic education in cardiovascular diseases.

Therapeutic education is a training offered and provided by health professionals, which enables the patient to acquire useful skills in order to understand better and manage their disease on a daily basis and learn how to react to difficult situations.

Therapeutic education, does it concern me?

Therapeutic education is aimed at all people, whatever the severity of their illness, as well as those around them. Integrated with care, it allows:

• To reduce hospitalisations and emergency calls

• To dicrease seizures and symtoms

• To improve daily life.

The Centre Hospitalier of Toulon and the MSA Provence Azur (which is a social security system) offer you three group therapeutic education sessions near your home. These completely free sessions, will enable you to manage your cardiovascular disease better.

Three therapeutic education sessions: why ?

Three sessions of three hours to learn how to:

• Get to know your disease,

• Identify your own risk factors of developing cardiovascular disease

• Know which food groups to reduce or favour

• Plan regular physical activity that is adapted to your situation

• Identify your warning signs of decompensation of the disease

• Know your medication to manager your treatment better

These therapeutic education sessions, of which content has been validated, are based on teaching materials and educational activities adapted to your situation.

These sessions take place in the therapeutic education room, on the 2nd floor of the Hôpital Sainte Musse in Toulon.