Recovering from Lung Reductio... Video Transcript

Participants

, Michael Argenziano MD, Paul J. Moniz , Byron Thomashow MD

Summary

Although post-surgery hospital time is as little as one week for some lung reduction patients, the full benefits of surgery may not be seen for months. Our panel will discuss short- and long-term recovery issues, from pain control to rehab.

Webcast Transcript

I'm Paul Moniz. Thank you for joining us on this webcast. Today's topic is life after volume reduction surgery on the lungs. This potentially life-saving surgery can give sufferers of chronic obstructive pulmonary disease, or COPD, new hope again.

If you or someone close to you is planning on having this procedure, you certainly want to know what to expect after it's done, and what reasonable expectations are, in terms of your success rate.

Here to talk about some of the side effects, the healing periods, are two specialists who both diagnose and treat this condition, as well as operate. We have Dr. Byron Thomashow, who is a pulmonologist at New York Presbyterian Hospital, and a clinical professor of medicine at Columbia University. Thank you for joining us. We also have Dr. Michael Argenziano, who is a fellow in cardiothoracic surgery at New York Presbyterian Hospital.

Dr. Argenziano, let's begin with you. A patient comes out of the operating room after this four-hour surgery. What happens post-operatively?

MICHAEL ARGENZIANO, MD: The patients who undergo lung volume reduction surgery are considered by us to be critically ill immediately post-operatively, because traditionally patients with such severe lung dysfunction really wouldn't even be considered candidates for any kind of surgery. The fact that we're taking these patients to the operating room and resecting lung really increases our awareness of potential problems.

Post-operatively, the main issues are that we try to keep their fluid levels down. The lungs don't tolerate a lot of fluid, especially after they've been operated on, especially if they're affected by emphysema. In addition, the patients have what we call chest tubes, little plastic tubes that come out through their chest wall, that help to drain the air that invariably will leak from the areas of resection.

PAUL MONIZ: How much pain are they in? We're talking about lungs that are physically cut.

MICHAEL ARGENZIANO, MD: Although the lungs are physically cut, believe it or not, there's absolutely no pain associated with the cutting of the lung. However, there is significant pain associated with the incisions that we make to get to the lung. The incisions are either a thoracotomy, which is an incision in the side of the chest, between the ribs, and involves cutting a lot of muscle. The second is a sternotomy, which is an operation that's used, for instance, for heart surgery as well.

Both these operations can be associated with lots of pain, and for that reason, all of our patients receive what we call thoracic epidural catheters. Catheters that are similar to those that are used in women who are delivering babies, in order to lessen the pain after the surgery.

PAUL MONIZ: Will a patient see improvement right away? Perhaps when they wake up?

MICHAEL ARGENZIANO, MD: Before I move on, I do also want to mention that another option, in terms of approach, is also thoracoscopy. There are surgeons that are performing this operation, and we have performed it, using thoracoscopes, which are little telescopes that are placed through small incisions in the chest. In selected patients, this can be an option that can minimize the incisions and therefore the pain.

PAUL MONIZ: In terms of the success rate, how soon after will a patient notice improvement?

MICHAEL ARGENZIANO, MD: Because the patients have been under general anesthesia for a prolonged period of time and have had large incisions which cause pain, and therefore restricted motion of the chest, they will often not notice any improvement. Certainly may feel worse for several days post-operatively.