Thoracotomy; Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS
Lung surgery is surgery to repair or remove lung tissue. Several common lung surgeries are:
- Biopsy of an unknown growth
- Lobectomy, to remove one or more lobes of a lung
- Lung transplant
- Pneumonectomy, to remove a lung
- Surgery to prevent the buildup or return of fluid to the chest (pleurodesis)
- Surgery to remove an infection or blood in the chest cavity (empyema)
- Surgery to remove small balloon-like tissues (blebs) that cause lung collapse (pneumothorax)
- Wedge resection, to remove part of a lobe in a lung
A thoracotomy is a surgical cut that a surgeon makes to open the chest wall.
You will receive general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video-assisted thoracoscopic 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 a surgical cut between two ribs. The cut will go from the front of your chest wall to your back, passing just underneath the armpit. These ribs will be separated.
- Your lung on this side will be deflated so that air will not move in and out of it during surgery. This makes it easier for the surgeon to operate on the lung.
- Your surgeon may not know how much of your lung needs to be removed until your chest is open and the lung can be seen.
- Your surgeon may also remove lymph nodes in this area.
- After surgery, one or more drainage 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 close the ribs, muscles, and skin with sutures.
- Open lung surgery may take from 2 to 6 hours.
Video-assisted thoracoscopic surgery:
- Your surgeon will make several small surgical cuts over your chest wall. A videoscope (a tube with a tiny camera on the end) and other small tools will be passed through these cuts.
- 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 fluids that build up.
- This procedure leads to much less pain and a faster recovery than open lung surgery.
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Why the Procedure Is Performed
Thoracotomy or video-assisted thoracoscopic 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
- Remove infection in the chest cavity
- Stop fluid buildup in the chest cavity (pleurodesis)
- Biopsy an unknown growth
- Remove a blood clot from the pulmonary artery (pulmonary embolism)
Video-assisted thoracoscopic surgery can be used to treat many of these conditions. However, sometimes video surgery may not be possible, and the surgeon may have to switch to an open surgery.
Risks for any anesthesia include:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery include:
- Blood clots in the legs that may travel to the lungs
- Heart attack or stroke during surgery
- Infection, including in the surgical cut, lungs, bladder, or kidney
Risks of this surgery include:
- Failure of the lung to expand
- Injury to the lungs or blood vessels
- Need for a chest tube after surgery
- Prolonged air leak
- Repeated fluid buildup in the chest cavity
Before the Procedure
You will have several visits with your health care provider and undergo medical tests before your surgery. Your health care provider 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
- Perform tests to make sure that you will be able to tolerate the removal of your lung
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 medications your doctor prescribed with small sips 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 thoracoscopic 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 walk as soon as possible after surgery
- Have tube(s) 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. Deep breathing exercises also help inflate the lung that was operated on. Your chest tube(s) will remain in place until your lung has fully inflated.
The outcome depends on:
- The type of problem being treated
- How much of the lung is removed
- Your overall health before surgery
Putnam JB Jr. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 58.
Wiener-Kronish JP, Shepherd KE, Bapoje SR, Albert RK. Preoperative evaluation. In: Mason RJ, Broaddus C, Martin T, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 26.
Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: Functional status predicts morbidity and mortality. J Surg Res. 2012: epub ahead of print.