תפריט

Pneumonectomy and lobectomy

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy, and that of a segment of the lung is referred to as a wedge resection (or segmentectomy).

Background

The most common pulmonary disease which requires a partial or complete resection of lung is lung cancer. This is the third most common disease that afflicts the general population and it doesn’t necessarily only affect smokers. Only after a comprehensive investigation of the patient’s health status, which includes checking the spread of the disease by computerized tomography, PET scans, respiratory function and cardiac tests, can the extent of surgery be determined. Need for a partial or complete resection of the lung, can only be determined at the end of the diagnostic process.

The operation

Today there are two ways by which the lobe of the lung may be removed. The conventional method includes opening the back and side of the thorax while spreading out the ribs. In this way the thoracic cavity can be entered and the diseased lobe or lung cut off together with the lymph nodes at all points around the heart.

During the last decade, a minimally-invasive technique has become a common method for removal of a lobe only. This method is performed by introducing a miniature television camera into the chest cavity, together with other three or four minimal entries to sever the affected lobe. It is important to note that this technique is intended only for patients with small tumors that are located in the lungs.

Are there any risks involved in the operation?

Despite the complexity of the surgery, the chances of success are high. However, complications could include bleeding, pneumonia and/or prolonged air leaks from the drainage tubes. It is important to note that with modern computerized technology, the actual percentage of complications is significantly lower than those described in the medical literature.

Anesthesia and sedation

Surgery is performed under general anesthesia. In addition, the anesthesiologist inserts an epidural catheter that will be used for several days after surgery.

During the first couple of days sedation is administered through an epidural catheter and the patient feels great relief. Duration of surgery is usually about an hour and a half, with patients spending their first night after surgery in the intensive care unit, even though they are fully conscious with spontaneous breathing. At the end of the operation a trocar or two will be seen exiting from the patient’s chest, and they will remain there for several days. After removal of the draining trocars epidural anesthesia is stopped, and pain management is administered by oral medications.

What should I know prior to the operation?

A candidate for a lobectomy or a pneumonectomy due to a malignant disease should be aware of the possibility that he/she might need to undergo additional treatment with chemotherapy or radiation therapy after surgery. This will only be known after receiving the pathology results.

Recovery and recuperation

After the trocar has been removed the patient will be able to do whatever he likes within reason. Naturally the incision will cause an uncomfortable sensation that will limit mobility. It is recommended that the patient undergo the recovery stage either in a convalescent facility or a lung rehabilitation institute if necessary.

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