What is a pulmonary lobectomy?

Pulmonary lobectomy is a complex surgery that currently has advanced techniques to perform. It involves a more or less long hospitalization that rarely exceeds 2 weeks.

Last update: November 21, 2021

Pulmonary lobectomy is a surgery to remove a lobe from a lung. Lobes are natural divisions within an organ. In the left lung there are 2 lobes and in the right there are 3.

This surgery is carried out when there is a localized cancer or injury. Pulmonary lobectomy is performed under general anesthesia and the goal is to remove diseased tissue.

Sometimes a pulmonary lobectomy is minimally invasive, meaning it only requires a few incisions. Other times it requires a large incision in the side, called thoracotomy.

What is a pulmonary lobectomy?

Pulmonary lobectomy is surgery to remove a lobe of the lungs. It can only be done if the problem affects a limited area of ​​the lung. By removing that affected area, the rest of the healthy tissue will allow the lung to continue to function.

In most cases, this type of intervention is done through a thoracotomy. This is an open surgery of the chest, in which an incision is made at the level of the affected lobe.

Sometimes video assistance is used to perform pulmonary lobectomy. If so, 3 or 4 small incisions are made instead of 1 large one. With this technique it is possible to see the internal organs by video and the removal is done with small tools that are inserted into the chest cavity.

In what cases is it used?

Pulmonary lobectomy is indicated when a problem is detected that is located in one lobe of the lung. In many cases it is used to treat cancer, as long as it has not spread.

In addition to cancer, the problems that can be treated with a pulmonary lobectomy include the following:

  • Pulmonary tuberculosis: this is a chronic infection caused by bacteria.
  • Lung abscess: It occurs when an area of ​​pus forms in the lung. If it does not respond to conservative treatment, the lobe will need to be removed.
  • Pulmonary emphysema: It occurs when the elastic fibers in the lungs break. This makes breathing difficult.
  • Benign tumor: a non-cancerous mass forms that can press on an important blood vessel and affect other nearby organs.
  • Yeast infection: it can lead to a serious condition.
Tuberculosis can progress to a chronic form with severe damage to the lungs.

Preparation for surgery

It may be paradoxical, but performing a pulmonary lobectomy requires the lungs to be as healthy as possible. To ensure that a person is fit to undergo this surgery, the doctor may order one or more of the following tests:

  • Laboratory analysis: blood and urine.
  • CT scan: to explore the anatomy and the disease itself.
  • Staging: It is done to find out what stage a cancer is in. It may include endobronchial ultrasound, positron emission tomography, or nuclear magnetic resonance imaging.
  • Cardiac evaluation: helps determine if the heart is able to tolerate surgery.
  • Evaluation of lung function: it allows to establish if the lung will support the extirpation of a lobe.

It is possible that after conducting these tests a pulmonary rehabilitation program will be indicated, with a view to making the lobectomy successful. It is also recommended to stop smoking, at least 3 weeks before the intervention.

The patient should arrange for help at home for the first few weeks after surgery. Likewise, it is advisable to maintain a healthy diet. You cannot eat or drink anything for 8 to 12 hours before your pulmonary lobectomy.

How is pulmonary lobectomy performed?

Pulmonary lobectomy requires hospitalization. The patient is first asked to remove clothing and put on a surgical gown. You will then lie on a table, where an IV will be placed in your arm or hand.

After general anesthesia is applied, a breathing tube is inserted into the throat, and the patient is connected to a mechanical respirator. A catheter is also often inserted into the bladder.

Open pulmonary lobectomy

This technique is also known as thoracotomy. An incision is made in the side of the chest that ranges from 3 to 8 inches. The cut is made in the back, below the shoulder blade, and extends to the side, below the armpit. The lobe is then removed.

The procedure can take between 1.5 and 4 hours. Before closing the incision, the surgeon places one or more drainage tubes into the chest cavity so that excess fluid or air is expelled through there.

CTAV pulmonary lobectomy

This is also known as video-assisted thoracoscopic surgery. The surgeon makes 2 to 4 incisions in the chest wall, up to 1.25 inches long. Then a thoracoscope is inserted through them, which is a thin, rigid tube with a special camera and light.

Also, other small tools are introduced to remove the lobe. The doctor will see the inside of the body on a screen and in this way can remove the affected area.

RATS pulmonary lobectomy

This variant is known as robot-assisted thoracoscopic surgery. The procedure is similar to the previous one, but in this case a high definition 3D camera is used. This allows the surgeon to obtain a magnified view.

On the other hand, the surgical tools or instruments are part of the robot that is inserted into the body. The surgeon manipulates them through a console. This procedure guarantees greater precision.

Recovery and care

After surgery, the patient must spend several hours in a recovery room. Upon awakening, pain relievers are applied. Sometimes an X-ray is also done to make sure the lungs are okay.

Afterwards, the patient must learn to breathe deeply so that the lungs expand again. This is usually accompanied by an oxygen supply.

Once at home, you should continue with breathing exercises and gradually increase physical activity. Likewise, it is important that you avoid smoke, chemical gases, environmental pollution and the spread of a respiratory infection.

Controls after a pulmonary lobectomy must be strict. This has to be accompanied by rehabilitation.

Risks to consider

The risks vary depending on the age, the problem that gives rise to the surgery and the previous state of health. The main ones are the following:

  • Infections
  • Bleeding
  • Pneumothorax, when air accumulates in the pleural space and this leads to the collapse of the lung.
  • Empyema or accumulated pus.
  • Pleural effusion, when fluid accumulation occurs in the space between the lungs and the chest cavity.

Recovery from a pulmonary lobectomy is only successful when the doctor’s instructions are followed to the letter.. Physical activity may cause discomfort, but it is necessary to regain proper lung function.

In rare cases, after surgery, problems such as irregular heartbeat, blood clots in the legs, or so-called postthoracotomy syndrome, which is a chronic pain in the area. Any abnormality should be consulted with the doctor immediately.

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