Lung surgery

Definition

Lung surgery is surgery to repair or remove lung tissue. Several common lung surgeries are:

• Lobectomy, to remove one or more lobes of a lung
• Wedge resection, to remove part of a lobe in a lung
• Pneumonectomy, to remove a lung.

A thoracotomy is an incision (cut) that a surgeon makes to open the chest wall. You will have a thoracotomy if you have open lung surgery.

See also:

• Lung transplant
• Lung biopsy
• Esophagectomy
• Bronchoscopy

Alternative Names

Thoracotomy; Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS

Description

You will receive general anesthesia before surgery. This will make you unconscious and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video-assisted thorascopic surgery (VATS).

Lung surgery using a thoracotomy is called open surgery. In this surgery:

• You will lie on your side on an operating table. Your arm will be placed above your head.
• Your surgeon will make an incision between 2 ribs. The incision will go from the front of your chest wall to your back. These ribs will be separated. Your lung on this side will be deflated so that air will not move in an out of it during surgery.
• Your surgeon may not know how much of your lung needs to be removed until your chest is open and your lung can be seen.
• Your surgeon may also remove lymph nodes in this area.
• One or more tubes will be placed into your chest area to drain out fluids that build up. These tubes are called chest tubes.
• After the surgery on your lungs, your surgeon will repair your ribs, muscles, and skin.
• Open lung surgery may take from 2 to 6 hours.

Video-assisted thorascopic surgery:

• Your surgeon will make several small incisions over your lungs. An endoscope (a tube with a tiny camera on the end) and other small tools will be passed through these incisions.
• You will have air pumped into your chest to help your surgeon see the area better.
• Then, your surgeon may remove part or all of your lung, drain fluid or blood that has built up, or do other procedures.
• One or more tubes will be placed into your chest to drain out fluids that build up.

Why the Procedure Is Performed

Thoracotomy or video-assisted thorascopic surgery may be done to:

• Remove cancer (such as lung cancer)
• Treat injuries that cause lung tissue to collapse (pneumothorax or hemothorax)
• Treat permanently collapsed lung tissue (atelectasis)
• Remove lung tissue that is diseased or damaged from emphysema or bronchiectasis
• Remove blood or blood clots (hemothorax)
• Remove tumors, such as solitary pulmonary nodule
• Inflate lung tissue that has collapsed because of disease or an accident

Video-assisted thorascopic surgery can be used to treat many of these conditions. But your surgeon may need to work in a larger area of your chest than this surgery will allow. In that case, you will need open surgery.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Infection, including in the incision, lungs, bladder or kidney
• Bleeding
• Heart attack or stroke during surgery

Risks of this surgery are:

• Injury to your lungs or blood vessels
• Need for a chest tube after surgery

Before the Procedure

You will have many doctor visits and medical tests before you have surgery. Your doctor will:

• Do a complete physical exam
• Make sure other medical conditions you may have, such as diabetes, high blood pressure, or heart or lung problems, are under control

If you are a smoker, you should stop smoking several weeks before your surgery. Ask your doctor or nurse for help.

Always tell your doctor or nurse:

• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription
• If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

During the week before your surgery:

• You may be asked to stop taking drugs that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), clopidogrel (Plavix), or ticlopidine (Ticlid).
• Ask your doctor which drugs you should still take on the day of your surgery.
• Prepare your home for your return from the hospital.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 5 to 7 days for open thoracotomy and 1 to 3 days after video-assisted thorascopic surgery. You may spend time in the intensive care unit (ICU) after either surgery.

During your hospital stay, you will:

• Be asked to sit on the side of the bed, and then walk, the same day you have surgery
• Have a tube coming out of the side of your chest to drain fluids
• Wear special stockings on your feet and legs to prevent blood clots
• Receive shots to prevent blood clots
• Receive pain medicine through an IV (a tube that goes into your veins) or by mouth with pills. You may receive your pain medicine through a special machine that gives you a dose of pain medicine when you push a button. This allows you to control how much pain medicine you get.
• Be asked to do a lot of deep breathing to help prevent pneumonia and infection and to inflate the lung that was operated on. Your chest tube will remain in place until your lung has fully inflated.

Outlook (Prognosis)

The outcome depends on the type of problem being treated, how much of the lung is removed, and how ill you are before surgery.

References

Smythe WR, Reznik SI, Putnam JB Jr. Lung (including pulmonary embolism and thoracic outlet syndrome). In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 59.