Lung surgery, also known as thoracic surgery, is a specialized medical field focused on treating diseases within the chest, excluding the heart. This intervention is commonly used to manage various conditions, including chronic infections, severe trauma, and most frequently, lung cancer. The process involves extensive patient evaluation, selecting the appropriate surgical technique, and determining the precise amount of tissue to be removed. This sequence ensures the best possible outcome while maintaining the patient’s long-term respiratory function.
Pre-Surgical Evaluation and Preparation
Before surgery, a comprehensive assessment determines if the patient is physically fit enough to withstand the operation and the resulting reduction in lung capacity. Diagnostic imaging, such as computed tomography (CT) scans and positron emission tomography (PET) scans, precisely maps the location and size of the affected area. These scans help surgeons plan the exact boundaries of the required tissue removal.
A primary focus is the pulmonary function test (PFT), which measures how well the lungs are working. PFTs assess lung volume and capacity, specifically measuring the forced expiratory volume in one second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO). These measurements predict the post-operative lung function, ensuring the patient will have enough remaining capacity to breathe comfortably after the diseased tissue is removed.
Patients also undergo cardiac clearance, often involving stress tests or electrocardiograms, to confirm the heart can handle the stress of surgery and general anesthesia. Logistical preparations include adjusting or pausing certain medications, such as blood thinners, and adhering to strict fasting guidelines before the procedure. This preparation minimizes the risks associated with the surgery and anesthesia.
Different Surgical Approaches
The method a surgeon uses to access the lung determines the physical approach and instrumentation required. The traditional method is an open thoracotomy, which requires a single, large incision made on the side or back, often spanning several inches. This technique necessitates spreading the ribs to allow the surgeon direct visual and manual access to the lungs and chest cavity.
Modern surgery often favors minimally invasive techniques, with video-assisted thoracoscopic surgery (VATS) being a common approach. VATS involves making several small “keyhole” incisions, typically between one and two centimeters, through which specialized instruments are inserted. A thoracoscope, a thin tube equipped with a camera, provides a magnified view of the operating field on a monitor, guiding the surgeon’s actions.
A further evolution is robotic-assisted surgery (RATS), which utilizes a similar small-incision approach but employs robotic arms. The surgeon controls these arms from a console, translating hand movements into precise, scaled movements of the instruments inside the patient. RATS offers enhanced dexterity and a three-dimensional view, which can be advantageous for complex resections. Both VATS and RATS are associated with less post-operative discomfort and a faster return to normal activities compared to an open thoracotomy.
Specific Types of Lung Procedures
Once access is established, the procedure type is defined by the amount of lung tissue removed, determined by the size and location of the disease. The least extensive removal is a wedge resection, where a small, peripheral, triangular piece of the lung is excised. This procedure takes only the affected area and a small margin of surrounding healthy tissue, preserving the maximum amount of functional lung.
A segmentectomy involves removing one or more defined bronchopulmonary segments, which are distinct, anatomically separate units within a lung lobe. This technique is more involved than a wedge resection but conserves more lung function than removing an entire lobe. It requires careful dissection to separate the affected segment from the adjacent healthy segments.
The most common procedure for early-stage lung cancer is a lobectomy, which involves removing an entire lobe. The right lung has three lobes, while the left lung has two. Removing one entire lobe is often necessary to ensure all diseased tissue is excised with clear margins. Surgeons meticulously seal the remaining lobe or lobes to prevent air leaks and maintain the integrity of the remaining lung structure.
The most extensive procedure is a pneumonectomy, which requires the removal of an entire lung. This is reserved for cases where the disease is centrally located, has spread across multiple lobes, or has extensively involved the major airways or blood vessels, making a lobectomy impossible. Given the significant impact on breathing capacity, this procedure is performed only when absolutely necessary and after confirming the patient can tolerate the loss of the entire organ.
Immediate Post-Operative Care
Immediately following the procedure, the patient is moved to a recovery area or an intensive care unit for close monitoring. A standard component of post-operative care is the placement of one or more chest drainage tubes. These tubes are inserted into the pleural space—the area between the lungs and the chest wall—to continuously remove any accumulating air or fluid, such as blood or serous fluid.
The drainage tubes are connected to a collection system that uses suction or water seal to help the remaining lung fully re-expand and ensure the surgical site heals properly. Pain management is initiated immediately, often utilizing regional anesthetic techniques like epidural catheters or paravertebral blocks to deliver targeted relief. This approach controls discomfort and allows the patient to breathe more deeply and participate in recovery activities.
Within hours of the surgery, patients are encouraged to begin early mobilization, which involves sitting up and walking short distances. Early physical activity is important for preventing common post-operative complications, such as pneumonia and blood clots, by promoting lung expansion and circulation. The chest tubes are removed once the drainage volume is minimal and there are no persistent air leaks, signaling that the lung is healing and fully inflated.