Pulmonary Lobectomy (Removal of a Lung Lobe)

(Removal of a Lung Lobe)

Definition

Lobectomy is the surgical removal of a lung lobe.

Parts of the Body Involved

Chest
Ribs
Lungs

Reasons for Procedure

A lobectomy is used to treat a variety of lung conditions, such as lung cancer [2] , congenital defects, cysts, tuberculosis [3] , fungal infections, abscesses, and emphysema [4] .

Lung Cancer

Risk Factors for Complications During the Procedure

Pre-existing heart [5] or lung condition
Advanced age
Obesity [6]
Smoking [7]
Diabetes [8]
Excessive alcohol intake [9]

What to Expect

Prior to Procedure

Your doctor will likely do the following:
- Physical exam
- Blood tests
- Urine tests
- Chest x-ray [10] —a test that uses radiation to take pictures of structures inside the body, especially bones [11]
- Pulmonary function test [12] —a test to assess the capacity of your lungs to undergo surgery
- Ultrasound—a test that uses sound waves to examine the lungs
- CT scan [13] —a type of x-ray that uses a computer to take pictures of structures in the body
- MRI scan [14] —a test that uses magnetic waves to make pictures of structures in the body
Review your medications with your surgeon; you may need to stop taking some of them.
Follow a special diet.
Take antibiotics or other medications.
Shower the night before the procedure using antibacterial soap.
Arrange to have someone drive you to and from the procedure, and arrange for help at home as you recover.
Eat a light meal the night before, and do not eat or drink anything after midnight.
Wear comfortable clothing the day of your procedure.

Anesthesia

General [15] anesthesia will be administered. You will be asleep for the duration of the procedure. A tube will be placed in your windpipe to help you breathe.

Description of the Procedure

There are two methods of performing a lobectomy:

In the first, your surgeon will make a large rib-spreading incision, and then locate and remove the lung lobe in which the tumor resides.
In a second method, robot-assisted thoracic procedures [16] , the surgeon will make several small incisions between your ribs through which a tiny camera and surgical instruments are inserted. While viewing the inside of your chest on a monitor, the doctor will locate and remove the cancer-containing lobe.

In most lobectomies, the surgeon will also remove lymph glands in your chest so they can be tested for any malignancy. After completing the procedure, your surgeon will place tubes in your chest to help drain the chest cavity and close the incision(s) with stitches or staples.

After Procedure

Once the anesthesia has worn off, you will be taken to a recovery room where you will be given fluids and medications through an intravenous (IV) line. You will be instructed to cough and walk frequently, and may use an incentive spirometer, which is a breathing exercise [17] device.

How Long Will It Take?

The procedure takes about 1-4 hours.

Will It Hurt?

You may feel some pain [18] as the anesthesia wears off, but pain [18] can be managed with medications.

Possible Complications

Infection
Bleeding
Anesthesia-related problems
Bleeding in the lung cavity (hemothorax)
Collection of air or gases in the lung cavity (pnemothorax)
Collapsed lung
Need for prolonged artificial respiration on a ventilator
Damage to neighboring organs or structures
Death

Average Hospital Stay

Your recovery in the hospital will be about 1-2 weeks.

Postoperative Care

You will receive instruction from your doctor about your diet and activities. You will likely be told to walk daily and limit lifting during the first few days after your surgery.

You will be prescribed medications to manage pain [18] and given instructions on how to take care of your incision.

Outcome

The goal of a lobectomy is to remove cancerous, defective, or infected tissue, so that the condition does not spread to other, healthy tissues.

Call Your Doctor If Any of the Following Occurs

Cough or shortness of breath
Coughing up yellow, green, or bloody mucus
New chest pain [18]
Signs of infection, including fever and chills
Redness, swelling, increasing pain [18], excessive bleeding, or discharge from an incision site
Pain and/or swelling in your feet, calves, or legs

RESOURCES:

American Cancer Society
cancer [19].org/">http://www.cancer [20].org/

National Cancer Institute
cancer [19].gov/">http://www.cancer [20].gov/

CANADIAN RESOURCES:

Canadian Cancer Society
cancer [19].ca/">http://www.cancer [20].ca/

National Cancer Institute of Canada
cancer [21].ca/">http://www.ncic.cancer [20].ca/

References:

Information for patients undergoing a thorascopic wedge/lobectomy. University of Michigan Department of Surgery website. Available at: http://thoracic.um-surgery.org/clinical/discharge_followup/teaching/tscope_lobe.shtml [22] .Accessed February 13, 2008.

Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia,PA: Saunder; 2005.

Robot-assisted thoracic procedures PIB. Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?account=hotk2 [23] . Accessed February 13, 2008.

Sabiston Textbook of Surgery. 17th ed. Philadelphia, PA: Saunders; 2004.

Thoracic lobectomy. New York-Presbyterian website. Available at: http://www.nyp.org/masc/lobectomy.htm [24] .Accessed February 13, 2008.

Last reviewed February 2008 by Rosalyn Carson-DeWitt, MD [25]

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical [26] advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health [27] provider prior to starting any new treatment or with any questions you may have regarding a medical [26] condition.