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surgery of the lung
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surgery of the lung
the techniques are changing alot and are more easy to do than before although the lung surgery technically is supposed to be be the easiest one, by lobulation and noe with the scopy is less invasive
lobectomy;
lung tissue removal;
pneumonectomy;
thoracotomy
Indications:
Lung surgery may be recommended for:
 cancer (lung cancer)  tumors (solitary pulmonary nodule) small areas of long-term infection (highly localized pulmonary tuberculosis or mycobacterium) pockets of infection (lung abscess) permanently enlarged (dilated) air tube (bronchus) (bronchiectasis) permanently enlarged (dilated) section of lung (lobar emphysema) permanently collapsed lung tissue (atelectasis) injuries with collapsed lung tissue (atelectasis, pneumothorax, or hemothorax) Video Assisted Lung and Chest Surgery (VATS)       Surgery is often done to get a closer look at the inside of the lungs and to help treat lung problems. If a mass is found in the lung, surgery can help determine its cause. If necessary, the mass may also be removed. Surgery may be done for other conditions, as well, such as a collapsed lung or fluid around the lung.
A Lung Mass
If a mass has been found in the lung, a biopsy (sample) can be removed and examined to determine whether the growth is benign (not cancerous) or malignant (cancerous). In addition, the exact location and size of the mass can be measured, and other areas can be examined to check whether the mass has spread. If the mass needs to be removed, its size, location, and spread determine how much of the surrounding lung also needs to be removed. Removal of part or all of the lung is called lung resection.
Fluid Around the Lungs
Fluid may collect in the area around the lungs. One common cause of fluid around the lungs is a lung infection, which may be a complication of certain types of surgery or an illness such as pneumonia. During surgery, tubes can be placed in the pleural space to drain fluid and help the lungs heal.
A Collapsed Lung
If a portion of the lung wall is thin or ruptured, air may leak into the pleural space. When air collects in the pleural space, the lung may collapse. This is known as collapsed lung or pneumothorax. Tubes placed during surgery can drain air from the pleural space so the lung re-expands. During surgery, the wall of the lung can also be repaired so it won't collapse again
Lung surgery involves entering the chest wall to get to the lung. There a two ways to do this.
Your surgeon will choose the method that's best for your condition Thoracoscopy
Thoracoscopy uses several small incisions. The surgeon places a thin tube containing a camera through one incision and can view the lungs on a video monitor
Thoracotomy
Thoracotomy uses a larger incision in the chest. This opening allows the surgeon to see the lungs directly.
Thoracoscopy is often used to repair a collapsed lung; to examine, biopsy, and stage a mass in the lung; or to drain fluid from around the lungs. During thoracoscopy, your surgeon can look into your chest and perform procedures through small incisions in the chest wall. If thoracoscopy can't be continued, a thoracotomy (open procedure) may be necessary. The Surgical Procedure
The anesthesiologist gives you general anesthesia, which lets you sleep and keeps you free from pain during surgery. Once you're asleep, you're positioned comfortably on your side.The surgeon inserts a thin, tubelike instrument containing a tiny camera through one of the incisions. This camera allows the surgeon to view your lungs on a video monitor. Surgical instruments are inserted through the other incisions.When the procedure is finished, one or more tubes may be temporarily placed in the chest to drain fluid and air. The incisions are then closed with sutures or staples.Risks and Complications
The risks of thoracoscopy include the following:
Recovering in the Hospital
After surgery, you'll wake up in the recovery area. At first you'll probably feel groggy and thirsty. An intravenous (IV) line provides you with fluids and medications to relieve pain, and monitors keep track of your breathing and heartbeat. To help keep your lungs clear and prevent inflammation, a respiratory therapist will teach you breathing exercises to do every hour or so. Depending on your condition, a nurse or therapist will help you get up and walk soon after your surgery to keep your blood moving and improve your healing. The hospital stay after a thoracoscopy is generally 1 to 4 days. If you have chest tubes, you won't go home until they're removed.
Recovering at Home
When you return home, follow your doctor's instructions about how to care for your healing skin and lungs. These instructions may include the following:
When to Call Your Doctor
Call your doctor if you have any of the following symptoms after your procedure:
During thoracotomy, your surgeon directly views your lungs, and the area around them. Surgical procedures may be done, such as removing part or all of a lung if a mass is present. Your surgeon will give you instructions on how to get ready for the procedure and explain what the surgery can do to help treat your condition. Anesthesia
The anesthesiologist can discuss the type of medications you'll be given during the procedure and answer your questions. General Anesthesia lets you sleep and keeps you free from pain during surgery. You may also receive an epidural, a thin, flexible tube, in your lower back. Medication flows through the tube to help relieve pain. Epidural medications can interfere with the muscle control in your lower body, so you may receive a bladder catheter to help drain your urine while the epidural is in place. Other pain-relieving procedures, such as a nerve block, may be done during the surgery.
Reaching Your Lungs
Once you're asleep, you're positioned comfortably on your side and covered with sterile drapes. Your surgeon then makes an incision across your side. Your rib cage is separated to expose your lungs.
The Surgical Procedure
The lung to be operated on is deflated, while a breathing tube helps your other lung continue working. The deflated lung can then be examined and any necessary procedure performed, including removing part or all of the lung. In some cases, nearby lymph nodes may be removed, as well. When the procedure is finished, one or more tubes are placed in the chest temporarily to drain fluid and air. Then the rib cage is repaired and the muscle and skin are closed with sutures or staples.
Risk and Complications
The risks associated with thoracotomy include the following:
Your Hospital Recovery
After surgery, you'll be moved to a recovery area where you can be closely monitored. From there, you may go to a special care unit and then to a regular room. During your recovery, you'll be given pain medications to help make you more comfortable. You may also be taught exercises to improve your breathing and your range of motion while you heal. The hospital stay after a thoracotomy varies from patient to patient, but it's often a week or longer.
Immediately After Surgery
When you first wake up from the anesthesia, you may feel groggy, thirsty, or cold. If the breathing tube given to you during surgery remains in place, you won't be able to talk. Flexible tubes in your chest drain air, blood, and fluid. Intravenous (IV) lines give you fluid and medications. Monitors record your heartbeat and the amount of oxygen in your blood. You may spend one or more days in this special monitoring unit before you're moved to a regular hospital room.
Managing Your Pain
As soon as possible, you'll begin to move around to improve your muscle strength and blood flow. Your nurse or a physical therapist will help you as you start to sit up and walk. Pain medications help make activity more comfortable. These medications may be given to you by a nurse, or a special pump may allow you to give yourself medication as you need it. If you received an epidural before surgery, it may remain in place for a few days to continue to relieve the pain of your incision.
Respiratory Therapy
Soon after your surgery, a nurse or therapist will teach you exercises to keep your lungs clear, strengthen your breathing muscles, and help prevent complications. The exercises include incentive spirometry, where you put your mouth around a plastic device and inhale as much air as you can. You will also be taught coughing and deep-breathing techniques and be asked to perform them regularly on your own.
Range of Motion Exercises
While you're in the hospital, your nurse or a physical therapist may teach you some range of motion exercises. These exercises help stretch and strengthen the muscles on the side of surgery to keep your shoulder moving freely. You may also be taught exercises you can continue to do at home while you heal.
Going Home
Before you leave the hospital, your doctor will review the results of your surgery with you and tell you what to expect during your recovery. You and your doctor can discuss any further treatment you may need for your condition, review the next stage of your treatment plan, and schedule follow-up visits. When you're ready to leave the hospital, have someone available to drive you home.
Each year, more than a million thoracic (chest) surgical procedures are performed in the United States for heart and lung disease, muscle and nerve disorders, ulcers and other serious illnesses.
Although surgery may be the best, or only way to treat the disease, patients can sometimes face a long and difficult recovery because traditional "open" thoracic surgery is highly invasive. In most cases, surgeons must make a long incision through chest muscles and then cut or spread the patient's ribs to reach the diseased area. As a result, patients may spend up to a week in the hospital and up to 4 to 6 weeks of recovery at home.
Now, a surgical technique known as video assisted thoracic surgery (VATS) is enabling surgeons to perform many common thoracic procedures in a minimally invasive manner. Depending on the type of procedure, most patients do not need intensive care, can leave the hospital in 1 to 3 days and, in many cases, are back to normal activities within a week.
What is video assisted thoracic surgery?
In most VATS procedures, surgeons operate through 2 to 4 tiny openings between the ribs while viewing the patient's internal organs on a television monitor. Each opening is less that one inch in diameter, whereas 6- to 10-inch incisions are not uncommon in open thoracic surgery.
What diseases can be treated with VATS?
Because it can offer patients significant advantages over open surgery, many surgeons believe that VATS will one day be used in the majority of all thoracic procedures. While not every patient is a candidate for video assisted thoracic surgery, VATS has been used to:
- Treat blebs on the lung (which can lead to a collapsed lung)
- Diagnose and treat fluid around the lung
- Diagnose and treat fluid around the heart
- Diagnose and treat mediastinal tumors (tumors in the area between the lungs)
- Diagnose, or stage, lung cancer
- Treat lung cancer in patients who cannot tolerate open surgery
- Reduce lung volume in emphysema patients
Can other diseases be treated with VATS?
In addition to lung and heart procedure procedures, VATS also has been used to treat:
- Myasthenia gravis (a disease resulting in weakened muscles and fatigue)
- Nervous system disorders (excessive hand sweating abnormally cold, painful upper hand and arm disorders)
- Severe ulcers
- Esophageal achalasia (a thickening of the muscle in the esophagus, which causes difficulty in swallowing)
Am I a candidate for VATS?
Although there are many benefits associated with VATS, it may not be appropriate for some patients, including those who have had previous thoracic surgery or who have some pre-existing medical conditions. Only a through medical evaluation by your personal physician, in consultation with a qualified thoracic surgeon can determine if video assisted thoracic surgery is appropriate for you.
How is VATS performed?
It is important to remember that neither VATS nor open thoracic surgery describes a specific surgical procedure. Instead, they describe the techniques a surgeon uses to gain access into the chest cavity or "thorax".
However, all VATS procedures generally start the same way. Patients are placed under general anesthesia and are typically positioned on their sides. Using a trocar (a narrow tube-like instrument), the surgeon gains access into the chest cavity through a space between the ribs. An endoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient's internal organs on a television monitor.
One of the most common VATS procedures is for preventing or repairing a collapsed lung. Called a video assisted blebectomy, the procedure involves removing diseased tissue, known as a bleb, which is like a blister on the lung. If the bleb ruptures, it forms a hole, and the lung begins to deflate or collapse.
To remove the bleb, the surgeon inserts three trocars: one for the endoscope and two for special instrumentation. After locating the bleb, the surgeon removes the diseased tissue and seals off the healthy portion of the lung using the MULTIFIRE ENDO GIA* stapler.
Following the procedure, the small incisions are closed with surgical tape or a stitch or two. In most cases, the incisions are barely visible after a few months.
What are the advantages of VATS?
Because surgeons operate through 2 to 4 tiny openings instead of a long incision, many VATS patients experience less pain, less scarring a shorter hospital stay and, in many cases, a quicker return to work and other normal activities than patients who undergo open surgery. In addition, because it is not necessary to spread or cut the ribs, patients avoid some of the "bone pain" associated with the open approach.
How long will I be in the hospital?
Most VATS patients are out of the hospital in 1 to 3 days, and less than 10% require intensive care. In comparison, most patients who undergo traditional procedures spend 5 to 7 days in the hospital.
When can I go back to work?
Some patients return to work and other normal activities in as little as a week after video assisted procedures. This compares with 4 to 6 weeks for patients who have open surgery. However, you should consult your doctor before returning to work or resuming other activities.
Should I be concerned that VATS is a new technique?
Minimally invasive surgical techniques have been used in gynecologic surgery for nearly 3 decades, and today, more than 90% of all gallbladder surgery is performed using these techniques. Most recently, surgeons have applied minimally invasive techniques to a broad range of procedures including hernia repair, appendectomy, hysterectomy, heartburn surgery and bowel surgery.
However, before undergoing any type of surgery, whether minimally invasive or open, you should ask your surgeon about his or her training and experience.
What can I expect after surgery?
After surgery, it is important to follow your doctor's instructions. If you are like most people who undergo a minimally invasive procedure, you will probably feel better in just a few days. However, it is important to remember that although you may feel great, your internal organs still need time to heal. So if your doctor says take it easy for a week or two, take it easy!
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