Lung Resection

Overview

A pulmonary resection, commonly known as lung resection, involves the surgical removal of a portion or the entirety of the lung. This procedure can be conducted using either minimally invasive surgery or open surgery, also known as thoracotomy.

Presently, the majority of lung resections employ minimally invasive techniques, utilizing one to four 1-inch incisions on the side of the body. A video camera and specialized instruments, including a surgical robot, are employed to remove sections of the lung. Importantly, the entry is made between the ribs, ensuring the ribs are not broken during the procedure. Alternatively, in less frequent cases, surgeons may opt for a thoracotomy incision (3.5 inches or 8 centimeters) beneath the shoulder blade, necessitating the spreading of ribs to access the chest.

The purpose of a lung resection is to enable surgeons to remove a damaged or diseased part of the lung. In some instances, a lung resection may also be employed by a doctor for diagnostic purposes, wherein a portion of the lung is taken for closer examination of tissue to better understand the underlying cause of a lung issue.

Parts of the lung

Each individual possesses a pair of lungs situated on either side of the chest. Specifically, the right lung consists of three lobes, which are the upper lobe, middle lobe, and lower lobe.

The left lung is slightly smaller to accommodate the space required for the heart and is composed of two lobes, which are the upper lobe and lower lobe.

Each lung has a tube known as a bronchus, connecting the lung to the trachea. The circulation of blood from the heart to the lungs occurs through the pulmonary artery, and subsequently, it returns to the heart via the pulmonary veins.

Types of lung resection

• Wedge resection: Extracting a wedge-shaped segment of lung tissue that is diseased or damaged.
• Segmentectomy: Surgically removing between one to four portions of a lung lobe while preserving the rest.
• Lobectomy: Surgical removal of an entire lobe from the lung.
• Bilobectomy: Extraction of two lobes from the right lung while preserving the remaining lobes.
• Pneumectomy: Complete removal of an entire lung by surgical intervention.

Types of lobectomy

In a standard lobectomy, doctors typically extract one lung lobe. Various other types of lobectomy procedures include:

• Sleeve resection: This involves the removal of one lobe, along with a portion of the main bronchus from the lung. The surgeon then reconnects the end of the main bronchus to the bronchus of a healthy lobe.
• Arterioplasty: During lobe removal, the surgeon takes out a section of the primary artery supplying blood to the lung. This necessitates a temporary blockage of blood flow to the lung, allowing the surgeon to remove a portion of the artery and sew in a patch as a replacement.

Reasons for undergoing the procedure

Lung resections are carried out by doctors in cases where the lung has suffered damage or is affected by disease, such as lung cancer or other pulmonary disorders. Additionally, a lung resection may be recommended by doctors for diagnostic purposes when assessing lung diseases.

A lung resection is utilized for the treatment of:

• Benign lung tumors.
• Lung cancer.
• Tumors that have metastasized to the lungs from other locations.
• Damaged lung tissue, including conditions such as bronchiectasis, emphysema, abscesses, and trauma.

Doctors may employ a lung resection for the collection of tissue samples, aiding in the diagnosis of:

• Cancer, whether originating in the lung or metastasized to the lung.
• Lung infections, including conditions like tuberculosis.
• Pulmonary nodules (abnormal growths).
• Inflammatory lung diseases, such as pulmonary fibrosis.

Risks

Given that lung resections are major surgical interventions, there is a potential for risks and complications to arise. These complications may encompass:

• Adverse reactions to anesthesia.
• Air leakage.
• Bronchopleural fistula (an abnormal connection between large airways in the lungs and spaces between the lung lining membranes).
• Hemothorax (bleeding in the chest cavity).
• Pulmonary embolism (blood clots originating in the legs and traveling to the lungs).
• Arrhythmia (irregular heartbeat).
• Infections, including pneumonia.
• Difficulty in pain management, possibly due to intolerance to standard pain medications.

 Before the procedure

Prior to a lung resection, your doctor will inquire about your medical history. Your hospital will provide you with detailed instructions, including the timeframe for abstaining from food and drink before the surgery. If you are a smoker, it is advisable to quit smoking as early as feasible before the scheduled surgery.

As part of the pre-procedure health assessment, you may also undergo:

• Blood test.
• Pulmonary function tests to assess breathing.
• Chest X-ray.
• Computed Tomography (CT) scan.
• Cardiac evaluations, including an electrocardiogram or exercise stress test.
• Magnetic Resonance Imaging (MRI).
• Positron emission tomography (PET) scan, a nuclear medicine imaging procedure.
• Bronchoscopic evaluation of lung lesions and lymph nodes.

During the procedure

Throughout your lung resection, you will be administered general anesthesia to induce a state of sleep. Surgeons can opt for either minimally invasive procedures (such as thoracoscopic or robotic surgery) or open surgery (thoracotomy) when conducting a lung resection.

Thoracoscopic surgery

Thoracoscopic surgery represents a minimally invasive approach, and your surgeon may opt for either of two types of minimally invasive procedures:

• Video-Assisted Thoracoscopic Surgery (VATS): In this method, your surgeon utilizes specialized instruments and observes images on a screen.
• Robotic Video-Assisted Thoracoscopic Surgery (RVATS): This approach involves your surgeon guiding robotic instruments with three-dimensional video guidance from a separate robot console.

Typically, thoracoscopic surgery lasts around three hours. Throughout this procedure:

• Your surgeon creates one to four incisions on your side.
• A thoracoscope (tube with a light and small camera) is inserted into the chest.
• The thoracoscope transmits images to a monitor, aiding the surgeon in the guidance of the procedure.
• Specialized instruments are inserted through the incisions to remove tissue.

Thoracotomy

A thoracotomy typically has a duration ranging from three to six hours. Throughout this procedure, your surgeon:

• Initiates an incision in your chest, separating and spreading your ribs.
• Executes the planned lung resection.
• Concludes the procedure by closing the incision.

After the procedure

Following a lung resection, your surgeon will insert tubes into your chest to facilitate the drainage of excess fluid and allow the release of surplus air, alleviating pressure in your chest and promoting effective breathing during the healing process. Typically, individuals retain these chest tubes for 48 to 72 hours after the surgery, although there are cases where tube placement may be required for an extended duration.

The duration of your hospital stay will be contingent upon the specific type of lung resection performed and the progress of your recovery. On average, individuals spend approximately two to three days in the hospital following a lung resection.

Following your surgery, you might experience a sensation of breathlessness. Your doctors may instruct you in coughing or deep breathing exercises to aid in keeping your lungs clear. Temporary discharge with supplemental oxygen might be necessary to expedite your recovery.

Outlook

The duration of your recovery following a lung resection can span from weeks to months. The pace of your recovery is influenced by:

• Your overall health.
• The type of resection you underwent.
• Any additional medical conditions you may have.
• Whether the surgery was open or minimally invasive.

After undergoing a thoracotomy, it’s typically advised to restrict activity for about one month. However, individuals who undergo VATS or RVATS procedures may resume their normal activities within two weeks. Your healthcare provider will provide personalized guidance for your recovery.