Lobectomy Lung Surgery

Lobectomy Lung Surgery

Lobectomy is a surgical procedure to remove the entire lobe of your lung due to lung cancer diagnosis, infection, COPD, or benign tumors. There are a total of five lobes of the lungs; three lobes of the right lung and two lobes of the left lung.

A lobectomy can either be performed as a few small incisions (less invasive) or one longer incision (thoracotomy: an opened chest surgery) on the affected side of the chest. In this procedure, the affected lobe and its nearby lymph nodes are also removed to prevent the possible spread of the disease.

Lobectomy is usually required for people having early-stage cancer in which the tumor is affected just one part of the lung, but it doesn’t affect when cancer has spread to your whole lung or other parts of your body. Healthcare providers may also recommend lobectomy to people who are suffering from the following lung diseases;

  • Tuberculosis (TB): An ongoing (chronic) bacterial infection
  • Lung abscess: Pus forms in the lung that doesn’t go away with the regular antibiotic medicine.
  • Emphysema: A chronic illness caused by the failure of the lung’s elastic fibers.
  • Benign tumor: An abnormal but noncancerous collection of cells that can propel the large blood vessels and affect the function of other organs.
  • Lung cancer: Type of cancer that may adversely affect the bronchi, lobes of the lungs, the pleural lining, or other lung tissue. 
  • Fungal infection

Types of Lobectomy Lung Surgery

  1. Thoracotomy: This is an open chest surgery in which the surgeon makes a long cut along the side of your chest to spread your ribs. So that, they can easily see and remove the affected lobe of your lung.
  2. VATS (video-assisted thoracic surgery): In this surgery, the surgeon makes two to four small cuts in the side of your chest of about 2 ½ inches for one cut and half-inch long for other cuts. Through these holes, they insert a tube with a tiny video camera to see inside and guide their tools. This surgery is more likely to heal faster with less pain as compared to Thoracotomy.
  3. Robotic surgery: This surgery is done by the robotic arms in which the surgeon sits at a console table next to you and just controls the robotic arms to operate. In this procedure, only three or four half-inch cuts exist between your ribs with less chance of bleeding, minimal infection, and a faster recovery.

Risks associated with Lobectomy

As every surgical procedure has certain risks associated with it. Likewise, lobectomy has various potential risks depending on general health conditions and other factors; 

  • Infections, such as pneumonia.
  • Heart problems, such as a heart attack or irregular heart rhythms.
  • collapsed lung, which prevents your lung from filling with air during inhaling.
  • Blood clots in the legs.
  • Bleeding
  • Pus that forms in the space between your lungs and the wall of your chest.
  • Air or fluid in the space between the lung and inner chest wall (pleural effusion).

Choosing a Surgical Technique

While deciding the type of lobectomy, the healthcare provider will consider the following factors based on his/her experience and level of comfort performing the lung surgery;

  • Characteristics of patients’ particular cancer
  • Location of tumor in the chest
  • Size of the tumor
  • Chances and risk of tumor’s spreading to nearby tissues
  • Intensity of pain
  • Condition of lungs before surgery
  • Patients’ overall health condition
  • Feedback from the healthcare team

Pre-surgery Preparation

Before lobectomy, your healthcare provider will perform the following activities to ensure the patient’s health condition, is able enough to successfully bear the surgery;

Review your complete medical history.

Conduct various tests/examinations such as;

  • Physical exam
  • Blood test
  • Heart test
  • Breathing tests (pulmonary function tests
  • Carefully review pre-operative medications and may recommend stopping some of your medicines or keep continuing or adding some other medicines (if and when required).
  • Explain the complete procedure of lobectomy and its related facts to the patient.
  • Ask the patient to sign the consent form (seek permission for surgery).
  • Ask the patient to stop smoking at least one month before surgery. 
  • Advise the patient to exercise daily for lungs betterment. 
  • Request the patient to stop eating and drinking at least 12 hours before surgery. 

During Surgery 

Lobectomy is a quite extensive and complicated surgery that may require an inpatient and longer stay in the hospital. The method of performing surgery may vary based on patients’ health conditions and surgeon experience. However, the general procedure of performing lobectomy includes the following steps; 

  • Ask the patient to wear a hospital gown and remove jewelry or other objects.
  • Make the patient lie down on an operating table.
  • Put an IV (intravenous) line into the patients’ arm or hand.
  • Give antibiotics to the patient before and after the procedure.
  • Give general anesthesia to the patient that prevents pain and lets him sleep during surgery.
  • Put a breathing tube into the patients’ throat and hooked up to a breathing machine (ventilator).
  • Continuously monitor the patients’ heart rate, blood pressure, and breathing during surgery.
  • Insert a soft and flexible tube (catheter) into the patients’ bladder to drain urine during surgery.
  • Trim the hair from the area of surgery and also clean it with an antiseptic solution.
  • Make an incision (cut) on the front of the patients’ chest at the level of the lobe to be removed. 
  • Use a special tool to spread the ribs apart.
  • Remove the affected lobe of the lungs.
  • Put one or more tubes into patients’ chest that help to remove air and fluid after surgery.
  • Close the cut with stitches (sutures) or staples. 
  • Put a bandage or dressing on the surgery area.
  • Insert a thin tube (epidural catheter) in the area of the lower spine to pass pain medicine into your back.

After Surgery

  • When the patient wakes up from surgery, he/she may feel sleepy.
  • The patient will be shifted to a recovery room, and then to a general ward.
  • Depending on the patients’ condition, he/she may be kept in a special care unit. 
  • Continuously monitor the heart rate, blood pressure, and oxygen levels.
  • Remove the catheter from the patients’ bladder when he/she is being able to get up and use the bathroom on their own. 
  • Remain the chest tube in place for approximately 2 days after the operation. 
  • Perform a chest x-ray right after the surgery, and may be repeated multiple times during patients’ stay in a hospital to make sure the health of the lungs. 
  • A respiratory therapist will teach the patient about coughing methods to help the lungs re-expand after surgery and prevent pneumonia. 
  • Ask the patient to perform the deep-breathing exercise regularly. 
  • Advise the patient to get up from the bed and walk around to help the lungs heal faster and prevent blood clots in the legs.
  • Prescribe the medications to the patient to reduce the post-surgery pain that will subside within 2 to 4 weeks.
  • Give the specific incision care instructions to the patient and plan for a follow-up appointment with the surgeon.
  • Open the stitches after 14 days of the surgery.

Side Effects of Surgery

Following are the common side effects of lobectomy lung surgery that often go away within 4 to 6 weeks;

  • Discomfort or itching from healing incisions
  • Muscle pain or tightness in the shoulders and chest
  • Fatigue (tiredness), mood swings, or depression
  • Sleeping problems or loss of appetite
  • Constipation

When to immediately call or visit to doctor?

The patient should immediately contact the doctor if he/she has felt or observed the following signs/symptoms;  

  • Fever greater than 100.4° F
  • New or severe pain in the chest or around the incision
  • A rapid heart rate
  • Shortness of breath 
  • Chest pain
  • Inflamed skin, bleeding, or pus-like drainage from the incision
  • Green, yellow, or blood-tinted phlegm

References:

  • https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/lobectomy#:~:text=A%20lobectomy%20is%20a%20surgical,lobes%20of%20your%20left%20lung retrieved on February 26, 2022. 
  • https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lobectomy retrieved on February 26, 2022.
  • https://www.webmd.com/lung-cancer/lobectomy-lung-surgery retrieved on February 26, 2022.
  • https://www.verywellhealth.com/lobectomy-as-a-treatment-for-lung-cancer-2249328 retrieved on February 26, 2022.
  • https://ctsurgerypatients.org/procedures/lobectomy retrieved on February 26, 2022.
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