Why Does Turkey Have Some of the Best Lung Cancer Surgeons?

Turkey has some of the best doctors performing lung cancer surgery thanks to the perfect harmony between the exceptional practical reflexes surgeons gain from the country’s unique patient diversity and its innovative medical ecosystem that meets global standards. This thoracic surgery experience, which has elevated our country to a leading position in global healthcare, is based not only on theoretical knowledge but also on thousands of hours of vital operating room experience. Patients seeking the most reliable paths to recovery in the face of the devastating nature of cancer confidently choose the strong and modern infrastructure offered by our country. Up-to-date treatment approaches that are completely personalized without deviating from oncological principles have made our country one of the world’s most frequently preferred reference centers, where promising outcomes are achieved.

Why Are Doctors in Turkey So Experienced in Lung Cancer Surgery?

There is a fundamental rule universally accepted in the medical world, particularly in surgical specialties. The more frequently and intensively a physician or clinic performs a specific type of operation, the greater their experience in that field and, consequently, the higher the likelihood of a positive surgical outcome. In the medical literature, this is referred to as the relationship between case volume and treatment success. Considering epidemiological realities such as our country’s population structure and smoking rates, tens of thousands of people are diagnosed with lung cancer every year. Although these figures may appear to be mere statistics on paper, in clinical practice they represent an enormous workload and hundreds of different patient stories encountered every day.

Thanks to this high patient volume, thoracic surgery clinics maintain a constantly active working pace. In early-stage lung cancer, surgical intervention is the most effective way to remove the disease from the body. However, human anatomy is not a flawless structure identical in every individual as depicted in medical textbooks. The origins of blood vessels, the angles at which the lung lobes adhere to one another, or tissue elasticity may vary significantly from person to person. Due to the high case volume, surgeons encounter thousands of different anatomical variations throughout their careers and develop extraordinary practical skill in managing these challenging situations. This deep clinical experience enables technical difficulties that may arise unexpectedly during surgery to be overcome calmly and effectively.

Some anatomical challenges frequently encountered and managed by surgeons during operations include:

• Unexpected vascular adhesions
• Atypical vascular branching
• Inflamed and enlarged lymph nodes
• Narrow chest cavity structure
• Pleural thickening

Such complex situations can only become safely manageable routine scenarios through years of accumulated experience and exposure to a large number of cases.

Which Stages Does Thoracic Surgery Specialty Training Include for Lung Cancer Surgery?

Achieving the competence required to operate on vital organs within the chest cavity demands one of the most challenging and lengthy training processes in the world. The specialty examination taken after six years of medical school is only the beginning of this demanding journey. After earning the right to specialize, physicians usually undergo a continuous residency period lasting approximately five years, filled with night shifts, emergency interventions, and intensive care duties.

During this long process, resident physicians do not merely learn how to hold a scalpel in the operating room. To evaluate a patient as a whole and remain prepared for every possible scenario, they must also receive training in different medical disciplines. An approach that views the patient solely in terms of the lungs is unacceptable in medicine. Therefore, the training curriculum includes mandatory rotations designed to improve the surgeon’s ability to manage patients systemically.

The main departments in which physicians complete rotations during training include:

• General surgery
• Cardiovascular surgery
• Pulmonology
• Anesthesiology and reanimation
• Intensive care unit

Through these rotations, surgeons learn the principles of wound healing, techniques for managing major vascular injuries, and how to prepare the respiratory capacity of patients with conditions such as asthma or COPD for surgery. They also gain command of anesthesia processes, including putting the patient to sleep, connecting them to a ventilator, and monitoring vital functions during surgery. The quality of training is rigorously supervised by national competency boards, and physicians certify their expertise by passing demanding examinations. This strong foundation enables doctors in our country to rise to leadership positions not only nationally but also in international associations and organizations.

Which Preparation Processes Are Applied Before Lung Cancer Surgery?

The period before entering the operating room is at least as important as the surgery itself. Once the disease is diagnosed, surgery is not scheduled immediately; first, the disease must be mapped in great detail. Using internationally accepted staging systems, the size of the tumor, its location, whether it has spread to the lymph nodes, and whether it has metastasized to another part of the body are thoroughly investigated. This staging process is the most critical step in determining the treatment roadmap.

The most advanced radiological and nuclear medicine imaging methods available today are used during the diagnostic process. The internal structure of the lung and its relationship with the vessels are examined in three dimensions. In particular, the condition of the lymph nodes around the heart and major vessels must be evaluated very carefully. Sometimes microscopic disease may be present even in lymph nodes that appear completely normal in size on tomography. To clarify this possibility, it may be necessary to enter the chest cavity with small cameras and obtain samples from the lymph nodes.

The principal examination methods used during the preparation stage include:

• Contrast-enhanced computed tomography
• Positron emission tomography
• Brain MRI
• Pulmonary function tests
• Cardiac echocardiography

All the data obtained are not left to the discretion of a single physician. The patient’s condition is discussed in detail by boards that also include specialists in medical oncology, radiation oncology, radiology, and pathology. If the tumor is slightly beyond the preferred limits for immediate surgery, drug treatments may first be administered to shrink the disease and make the operation safer. In addition, if the patient smokes, quitting several weeks before surgery makes a vital difference during postoperative recovery. The reactivation of the cleansing cells in the airways helps the patient experience a more comfortable postoperative period.

What Benefits Does VATS, a Minimally Invasive Lung Cancer Operation, Provide to Patients?

In previous years, the only method used to reach the organs within the chest cavity was open surgery known as “thoracotomy.” In this technique, a large incision was made between the ribs, and the ribs were forcefully separated using metal instruments. The delicate nerves running beneath the ribs and controlling the muscles involved in breathing were subjected to significant pressure during this procedure. When patients woke from surgery and even for months after discharge, they often had to cope with severe chronic pain that caused a stabbing sensation with every breath. This made deep breathing and coughing difficult, creating conditions for mucus accumulation in the lungs.

Today, with advances in medical technology, minimally invasive surgical methods, medically known as Video-Assisted Thoracoscopic Surgery (VATS), have gained wide application. In this technique, large incisions are not made in the patient’s chest. Instead, thin high-resolution cameras and specialized surgical instruments are introduced through small openings. The surgeon views the operative field magnified on large monitors and controls the procedure externally. Because the ribs are not spread apart and the nerves are not compressed, trauma to the chest wall is considerably reduced.

The main advantages of minimally invasive surgery for patients include:

• Less surgical pain
• Shorter hospital stay
• Smaller and more aesthetically favorable scars
• Reduced blood loss
• Faster return to daily life

Patients require significantly less pain medication after minimally invasive surgery. Being able to stand and walk shortly after the operation allows them to ventilate their lungs fully and accelerate the recovery process.

Why Is Uniportal VATS, Lung Cancer Surgery Performed Through a Single Incision, Preferred?

The evolution of minimally invasive surgical methods has taken the medical world to an even more remarkable level. While standard minimally invasive operations require three or four small openings in the chest for the camera and instruments, Uniportal VATS allows the entire complex oncological procedure to be performed through a single small incision. Both the camera providing visualization and all the instruments used to cut and suture tissues are inserted through this single opening, which is only a few centimeters long on average.

Although this technique offers tremendous comfort for patients, it requires exceptional mastery and a different type of hand-eye coordination from surgeons. In conventional multiport surgery, grasping tissues with instruments introduced from different angles is easier, whereas in single-incision surgery all instruments must pass through the same narrow tunnel. Performing the procedure without the instruments colliding or damaging delicate vessels adjacent to the heart requires the surgeon to possess an extremely advanced three-dimensional understanding of anatomy. When applying this method, surgeons display workmanship comparable to artisans building a model ship inside a narrow bottle.

Special instruments used by the surgeon during single-incision operations include:

• Flexible camera systems
• Advanced tissue-cutting devices
• Automatic stapling instruments
• Fine-tipped vascular graspers
• Endoscopic clip applicators

Limiting the incision to a single area largely protects the intercostal nerve network. Patients are generally able to get out of bed and begin walking very quickly after surgery. Reduced manipulation of lung tissue during the procedure also allows for a much more comfortable postoperative recovery.

Can Lung Cancer Surgery or Biopsy Be Performed Without General Anesthesia?

When we hear the word surgery, we usually imagine the patient being completely anesthetized, connected to a ventilator, and lying on the operating table for hours without feeling anything. However, in patients with severely reduced respiratory capacity due to advanced age, serious heart disease, or chronic obstructive pulmonary disease (COPD), general anesthesia may sometimes become more dangerous than the operation itself. The medical world therefore had to develop alternative approaches for these high-risk patients.

This is where surgical techniques performed while the patient remains conscious and continues breathing independently come into play. Deep general anesthesia is not administered, and muscle relaxants that stop breathing are not used. Only the nerves in the chest wall where the procedure will be performed are numbed with special injections, and the patient receives a mild sedative. While the patient remains awake, the surgeon enters the chest cavity using minimally invasive techniques and carries out the necessary procedure. Because the patient is not connected to a ventilator, many risks associated with general anesthesia are avoided.

Some procedures frequently performed using awake minimally invasive techniques include:

• Pleural biopsy
• Drainage of pleural fluid
• Wedge resection
• Pleurodesis

This method is particularly beneficial for frail patients with pleural fluid accumulation and shortness of breath, allowing them to receive treatment without the heavy burden of general anesthesia. Immediately after the procedure, patients can return to their rooms and begin eating and drinking.

How Does Robotic Lung Cancer Surgery (RATS) Transform the Process?

One of the most fascinating achievements in surgical instruments and engineering is undoubtedly robotic surgery technology. However, the term “robotic surgery” can sometimes create a misconception among patients; there is no autonomous machine making decisions and performing the operation independently. An experienced surgeon still performs the entire procedure from beginning to end, while the robot serves as a highly advanced intermediary system that elevates the surgeon’s visual and manual abilities beyond normal human limits.

In standard minimally invasive surgery, the surgeon stands beside the patient and operates using long rod-shaped instruments. Robotic surgery is entirely different. The surgeon sits at a specialized console located several meters from the patient. Looking into the console, the surgeon sees the chest cavity in three dimensions, with exceptional depth perception and magnification far beyond normal vision. Sensors attached to the surgeon’s fingers instantly and precisely transmit even the smallest hand movements to the millimeter-scale robotic arms inside the patient’s body.

The principal advantages robotic systems provide to surgery include:

• High-resolution three-dimensional visualization
• Filtering of hand tremors
• Wide range of motion of articulated arms
• Easy maneuverability in narrow spaces
• Ergonomic seated position for the surgeon

Because of the anatomical structure of the human hand, the wrist can rotate only within a certain range. Robotic arms, however, have specialized joints capable of rotating almost completely around themselves. This feature provides the surgeon with remarkable precision, especially when removing deep lymph nodes located behind the heart or around the trachea where cancer may spread. Diseased tissues can be carefully removed while safely navigating between tiny blood vessels. Turkish physicians have gained sufficient experience with this complex system to train not only colleagues in their own country but also surgeons around the world.

Which Types of Resection Are Performed During Lung Cancer Surgery?

The structure of our lungs resembles a house with separate rooms rather than a single balloon. The right lung contains three large compartments, while the left lung contains two because the heart occupies space on that side. These compartments are medically called lobes. Each lobe has its own artery supplying oxygenated blood, vein carrying deoxygenated blood away, and bronchial branch carrying air. The main objective of lung cancer surgery is not merely to remove the tumor like a seed but to completely remove the compartment containing it together with its vessels and airways, thereby minimizing the risk of residual disease.

The extent of surgery varies according to the tumor’s size, location, and the patient’s general health. Surgeons must completely remove diseased tissue while preserving enough healthy lung tissue for the patient.

The principal lung resection methods used in surgical oncology include:

• Lobectomy
• Pneumonectomy
• Segmentectomy
• Wedge resection

The standard and most commonly performed procedure today is lobectomy, meaning complete removal of the lobe containing the tumor. However, if the tumor has grown extensively and spread to major structures, removal of the entire lung on the affected side may become necessary; this is known as pneumonectomy. On the other hand, if the disease is detected at a very early stage or the patient cannot tolerate losing an entire lobe because of advanced age or other illnesses, lung-preserving procedures such as segmentectomy or wedge resection may be preferred. These decisions are tailored entirely to the individual patient with the precision of a custom-made plan.

How Do Advanced Surgical Methods Affect Life After Lung Cancer Surgery?

A successful lung cancer operation is the most important step in the treatment process, but it is not the end of the journey. The greatest benefit minimally invasive or robotic surgical techniques offer becomes apparent during postoperative recovery. The major stress caused by open surgery keeps the immune system occupied for a long time. However, the immune system’s primary role should be to fight any microscopic cancer cells that may remain in the body. Since minimally invasive procedures require less energy for wound healing, the patient’s resistance remains stronger.

Rapid recovery also provides a major advantage for additional treatments that may be required after surgery. If pathology results indicate that the patient needs adjuvant chemotherapy or immunotherapy, these drug treatments can begin on time and at full dose without waiting through a prolonged recovery period. This positively affects the patient’s chances of overcoming the disease completely. After discharge, taking care of personal health is just as important as the surgery itself.

The fundamental rules patients should follow in daily life after surgery include:

• Avoiding cigarette smoke completely
• Performing the prescribed breathing exercises regularly
• Taking regular light-paced walks
• Following a healthy, protein-rich diet
• Attending regular physician follow-up appointments

Prof. Dr. Alper Fındıkçıoğlu

Prof. Dr. Alper Fındıkcıoğlu graduated from Istanbul University Faculty of Medicine and completed his thoracic surgery residency at Dr. Siyami Ersek Hospital. He began his academic career at Başkent University in 2005; he received the title of associate professor in 2014 and professor in 2022. He has extensive experience in lung cancer, chest wall diseases, and minimally invasive surgery. Since 2024, he has been continuing his professional work at Acıbadem Hospital.