Thoracic surgery is any surgery performed in the chest (thorax) Purpose: The purpose of thoracic surgery is to treat diseased

or injured organs in the thorax, including the esophagus (muscular tube that passes food to the stomach), trachea (windpipe that branches to form the right bronchus and the left bronchus), pleura (membranes that cover and protect the lung), mediastinum (area separating the left and right lungs), chest wall, diaphragm, heart, and lungs.

General thoracic surgery is a field that specializes in diseases of the lungs and esophagus. The field also encompasses accidents and injuries to the chest, esophageal disorders (esophageal cancer or esophagitis), lung cancer, lung transplantation , and surgery for emphysema.

Lobectomy A lobectomy removes part of the lung to get rid of a cancerous tumor. During the procedure, the lymph nodes in the tissues surrounding the lung may also be taken out and tested for lung cancer cells. Most people need to stay in the hospital for about five to seven days after a lobectomy. Although your symptoms may improve after the procedure, it is important to remember that it is not a cure in all cases.

What Is a Lobectomy? Lobectomy is a procedure that is used to take out part of the lung (called a lobe), because it has a cancerous tumor in it. It is used to relieve some or all of the lung cancer symptoms that a person is feeling. A lobectomy can keep a person's health from getting worse and it may provide the best chance for curing the disease.

Preparing for Lobectomy Lobectomy is performed on an inpatient basis, which means you will stay in the hospital after the procedure. Some people also stay overnight before the lobectomy. Your healthcare provider should give you specific instructions, telling you where and when to arrive at the medical facility, how to prepare for your procedure, and what to expect the day of and the days following your lobectomy. You will be asked to not eat or drink anything for at least eight hours before the lobectomy. Following the lobectomy, most people need to stay in the hospital for about five to seven days. Some people need to stay longer. You may want to have someone drive you to the hospital and help you get settled in.

Complications of Lobectomy No procedure is ever completely free of risks. However, lobectomy has been performed for many years with successful results and limited complications. Some lobectomy complications include, but are not limited to: Infection Bleeding Heart attack Stroke Lobar torsion Irregular heart rhythm.

If any of these lobectomy complications develop, the treatment will depend on where it happens, how serious it is, and other factors, including your overall health.

You may need to stay in the hospital longer than planned, and for some complications you might even need to have a blood transfusion or another surgery.

Summary of Lobectomy

The goal of a lobectomy is to take out part of a lung that has a malignant tumor. Recovering from a lobectomy may take time, but the surgery can help you live longer and feel better. Some of your symptoms may improve after lobectomy, but it's important to remember that this may not be a cure. Each person will have different results depending on his or her health, as well as the size, type, and location of the tumor.

PNEUMONECTOMY
A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as alobectomy, and that of a segment of the lung as a wedge resection (or segmentectomy).

A pneumonectomy is most often used to treat lung cancer when less radical surgery cannot achieve satisfactory results. It may also be the most appropriate treatment for a tumor located near the center of the lung that affects the pulmonary artery or veins, which transport blood between the heart and lungs. In addition, pneumonectomy may be the treatment of choice when the patient has a traumatic chest injury that has damaged the main air passage (bronchus) or the lung's major blood vessels so severely that they cannot be repaired.

An chest x-ray of a person who has had their right lung removed

The most common reason for a pneumonectomy is to remove tumourous tissue arising from lung cancer. In the days prior to the use of antibiotics intuberculosis treatment, tuberculosis was sometimes treated surgically by pneumonectomy. The operation will reduce the respiratory capacity of the patient; before conducting a pneumonectomy, the surgeon will evaluate the ability of the patient to function after the lung tissue is removed. After the operation, patients are often given an incentive spirometer to help exercise their remaining lung and to improve breathing function. A rib or two is sometimes removed to allow the surgeon better access to the lung.

TYPES
There are two types of pneumonectomy:

Simple pneumonectomy: removal of

just the affected lung Extrapleural pneumonectomy (EPP): removal of the affected lung, plus part of the diaphragm, the parietal pleura (lining of the chest) and the pericardium (lining of the heart) on that side. The linings are replaced by Gore-Tex in this radical and painful surgery that is used primarily for treatment of malignant mesothelioma.

Wedge Resection (Segmentectomy)

What is a wedge resection:

A wedge resection is the surgical removal of

a small portion of the lung along with healthy tissue that surrounds the lung. is a surgical procedure to remove a triangleshaped slice of tissue. It may be used to remove a tumor or some other type of tissue that requires removal and typically includes a small amount of normal tissue around it. It is easy to repair, does not greatly distort the shape of the underlying organ and leaves just a single stitch line as a residual.

Why is a wedge resection performed: A wedge resection is performed to removal a lung tumor, or to diagnose lung cancer. Who is a candidate for a resection: A wedge resection is performed in early stage non-small cell lung cancer. Lung functions and general health is assessed by a battery of tests prior to the surgery. The type of tumor is also taken into consideration.

How is a wedge resection performed: A thoractomy or VATS (video assisted Thoracoscopic Surgery) is performed and a wedge shaped section if the lung is removed. The incision is then closed, and a chest tube is inserted to allow the drainage of fluids that may buildup in the lung. Risks: Risks of wedge resection surgery include reaction to general anesthesia, bleeding, infection, pneumonia, blood clots, and general difficulty breathing after surgery.

Recovery: Recovery after a wedge resection is generally a week long hospital stay with respiratory therapy sessions. The chest tube is removed once the lung has fully exapanded. The patient is noramlly advised no heavy lifting for at least 8 weeks. Most patients return to work after 8 weeks. Recovery varies from patient to patient.

Sleeve Lobectomy

A surgical procedure that removes a cancerous lobe of the lung along with part of the bronchus (air passage) that attaches to it. The remaining lobe(s) is then reconnected to the remaining segment of the bronchus. This procedure preserves part of a lung, and is an alternative to removing the lung as a whole (pneumonectomy).

Segment Resection (Segmentectomy)

A segment resection removes a larger portion of the lung lobe than a wedge resection, but does not remove the whole lobe.

Lung Volume Reduction Surgery (LVRS) Lung volume reduction surgery (LVRS) was first used to treat emphysema in the 1950s after being described by Dr. Otto Brantigan at the University of Maryland. It was not widely practiced because of the uncertainty surrounding its long-term benefits and high-risk mortality. Thanks to medical developments, physicians began using LVRS in the 1990s to help treat people with severely disabling emphysema.

Candidates for Surgery

The National Emphysema Treatment Trial (NETT) study results identified four sub-groups of patients who had different risks and benefits from LVRS. Those groups include: Group 1: Mostly upper-lobe emphysema and low exercise capacity. These patients were more likely to live longer and were more likely to function better after LVRS than after medical treatment. Group 2: Mostly upper-lobe emphysema and high exercise capacity. These patients are more likely to function better after LVRS than after medical treatment, but there was no difference between the LVRS and Medical participants in survival.

 Group 3: Mostly non upper-lobe emphysema and low

exercise capacity. These patients had similar survival and function after LVRS as after medical treatment. Group 4: Mostly non upper-lobe emphysema and high exercise capacity. These patients had worse survival after LVRS than after medical treatment; both LVRS and medical participants had similar low chance of functioning better.

A high-risk patient has been defined by NETT criteria as a patient who would not benefit from LVRS but is more likely to be harmed, as outlined in Group 4. Specifically, the high-risk patient is one who has a forced expiratory volume in the first second (FEV1) that is 20% or less of their predicted value and either homogenous distribution of emphysema on CT Scan or low carbon monoxide diffusing capacity (DlCO) that is 20% or less of their predicted value. These specific criteria can be determined after the testing process has been completed. Finally, a patient with a certain underlying medical disease, condition or multiple surgical risk factors may also not be a surgical candidate for LVRS.

Risk Factors
There are numerous risks involved with

lung reduction surgery. Lung reduction surgery has a higher risk than heart surgery, because the candidates have poor lung function and are generally older in age. The death rate for this surgery is approximately 6 to 10 percent nationwide. This is one of the highest risk elective procedures performed.

 Thoracoscopy (Unilateral or

eventually dissolve are used to Bilateral) close the incisions. This technique can be used to Thoracoscopy is a minimally invasive technique. Three small operate on either one or both (approximately 1-inch) incisions lungs and allows assessment are made in each side, between and resection of any part of the lungs. your ribs. A video-scope is placed through one of the incisions. This scope allows the surgeon to see your lungs. A stapler and grasper are inserted in the other incisions. These are used to cut away the most damaged areas of the lung. The stapler will reseal the remaining lung. Sutures that will

Sternotomy (Bilateral) An incision is made through the breastbone to expose both lungs. Both lungs are reduced at the same sitting in this procedure, one after the other. The chest bone is wired together and the skin is closed. This is the most invasive technique, used when thoracoscopy is not appropriate. This approach is usually used for upper lobe disease only.

Thoracotomy(Unilateral or One-Sided)

For the thoracotomy technique, an incision is made between your ribs. The incision is approximately 5 to 12 inches long. Your ribs are

surgeon is unable to see the lung clearly through the thoracoscope or when dense adhesions (scar tissue) is found.

separated, not broken, and your lungs are seen. Only one lung is reduced with this procedure. Your muscle and skin are closed by sutures. Thoracotomy is often used when the

Complications

Air leakage -- This is the most common complication with over 50% of patients reporting some degree of air leakage. Air leakage occurs when air leaks from the lung tissue, coming from the suture line, into the chest cavity. If the air volume becomes too great, the pressure could

collapse the lung tissue. One or more chest tubes are placed during surgery to monitor air leakage and prevent the collapse of the lung tissue. Pneumonia (19%) or infection (1-5%) is common in emphysema patients, especially when they have a history of these conditions. Stroke (less than 1%) Bleeding (2-5%) Heart attack (1%) Death that results from a worsening of one of the above complications (6-10%)

The Hospital Experience Patients should expect to stay approximately 5 to 10 days on the Cardiothoracic Surgical Care Units. Most patients stay in the Intensive Care Unit (ICU) for at least two days. Expect to be up in the chair and walking within hours of surgery.

Pulmonary Rehabilitation
Pulmonary rehabilitation will start on your first post-operative day. These exercises and training are very important for your recovery. The more you exercise and move, the quicker and less painful your recovery will be. Your motivation to recover strongly affects this part of your treatment. You may not feel up to exercising, but you must. Listen to the nurses and therapists; they will be important keys in your recovery. You will be walking in the halls, on the treadmill or on the bicycle everyday!