Lung surgery, also known as thoracic surgery, encompasses procedures designed to treat diseases affecting the lungs, chest wall, and diaphragm. These operations vary dramatically in complexity, ranging from obtaining a small tissue sample to replacing an entire organ. Lung surgery is primarily categorized by the amount of tissue removed and the technique used to access the chest cavity. This classification helps determine the most effective treatment for conditions like cancer, trauma, or end-stage lung disease.
Categorization by Extent of Tissue Removal
The most significant category of lung surgery involves resection, which is the removal of diseased lung tissue. These procedures are distinguished by the specific anatomical amount of lung structure removed.
The largest form of resection is a pneumonectomy, a major operation where the surgeon removes an entire lung. This procedure is usually reserved for advanced cancers or widespread infection that cannot be controlled otherwise.
A lobectomy is the most common resection performed for early-stage lung cancer, involving the removal of one of the lung’s lobes. The right lung has three lobes and the left has two. This operation is considered an anatomic resection because it follows the natural boundaries of the lung’s internal structure, preserving the maximum amount of healthy, functional lung.
Smaller, lung-sparing resections are categorized as sublobar procedures, which include segmentectomy and wedge resection. A segmentectomy removes one or more segments within a lobe, preserving more lung function than a lobectomy. This anatomic resection is an option for smaller tumors or for patients with limited breathing capacity.
A wedge resection is the least extensive type of removal, taking out a small, triangular piece of tissue containing the disease and a margin of healthy lung. This is a non-anatomic procedure, as the cut does not follow the lung’s bronchial or vascular architecture. Wedge resections are frequently used for diagnosis, removing benign nodules, or for patients too frail to tolerate a more extensive operation.
Defining the Surgical Approaches
Lung surgery is also defined by the technique used to reach the diseased area. The traditional method is a thoracotomy, which is an open surgery requiring a long incision made between the ribs. This approach offers the widest view and the most direct access, often necessary for complex cases, large tumors, or extensive scar tissue.
Most lung resections are now performed using minimally invasive techniques, which utilize small incisions. Video-Assisted Thoracoscopic Surgery (VATS) involves inserting a camera and specialized instruments through small ports in the chest wall. The surgeon views the procedure on a video monitor, resulting in reduced pain and a faster recovery compared to a standard thoracotomy.
Robotic-Assisted Thoracic Surgery (RATS) is an evolution of VATS, where the surgeon controls highly precise robotic arms from a console. The robotic platform offers technical advantages, including three-dimensional visualization and instruments that mimic the dexterity of a human wrist. Both VATS and RATS can be used to perform resections like a lobectomy or a segmentectomy.
Procedures Focused on Diagnosis and Drainage
Not all lung surgeries involve tissue removal; many focus on diagnosis, symptom relief, or drainage.
Thoracentesis is a common procedure involving the insertion of a needle through the chest wall to drain abnormal fluid accumulation from the pleural cavity. This is often performed to relieve pressure causing shortness of breath or to obtain a fluid sample for analysis.
Tissue sampling, or biopsy, is performed using various methods to determine the cause of an abnormality. A bronchoscopy-guided biopsy uses a thin, flexible tube with a camera, called a bronchoscope, passed through the nose or mouth into the airways. Tiny instruments are then passed through the scope to collect tissue samples, a method often called transbronchial biopsy.
Another non-resection operation is pleural decortication, a major procedure reserved for chronic conditions. This involves removing a thick, fibrous membrane—or “peel”—that forms around the lung, often due to long-standing infection or fluid buildup. Removing this peel allows the lung to fully expand again, significantly improving the patient’s breathing.
Lung Transplantation
The most complex form of lung surgery is transplantation, which is the replacement of a diseased lung with a healthy one from a donor. This procedure is reserved for patients suffering from end-stage lung disease when all other options have been exhausted. The decision to perform a single or double lung transplant depends on the patient’s underlying disease and overall health.
A single lung transplant involves replacing only the most damaged lung, often suitable for older patients or those with emphysema. For younger patients or those with infectious conditions like cystic fibrosis, a double lung transplant (bilateral sequential lung transplant) is typically performed. This extensive procedure requires the surgeon to connect the main airway, pulmonary artery, and pulmonary veins of the new organ to the recipient’s circulatory system.