A pleurectomy is a medical procedure involving the removal of part or all of the pleura, a delicate membrane surrounding the lungs. It is often considered when other treatments have not provided sufficient relief for various lung conditions.
Understanding the Pleura
The pleura is a thin, double-layered membrane that envelops each lung and lines the inside of the chest cavity. The outer layer, the parietal pleura, attaches to the chest wall, while the inner layer, the visceral pleura, directly covers the lungs. These two layers are continuous at the lung’s hilum, where major airways and vessels enter and exit.
Between these layers is the pleural cavity, a narrow space containing a small amount of serous fluid. This fluid acts as a lubricant, allowing the pleura to glide smoothly during the expansion and contraction of the lungs with each breath. The fluid also creates a surface tension that helps keep the lung adhered to the chest wall, facilitating proper lung expansion during inhalation. This intricate arrangement ensures efficient and comfortable respiration, cushioning the lungs and preventing friction against the chest wall.
What a Pleurectomy Is and Why It’s Performed
A pleurectomy is a surgical procedure that involves removing either a portion or the entirety of the pleura. This surgery aims to alleviate symptoms, improve quality of life, and in some cases, extend survival for individuals with specific pleural conditions.
One common reason for a pleurectomy is recurrent pleural effusions, the persistent buildup of fluid in the pleural cavity. When fluid repeatedly accumulates, it can compress the lung, leading to shortness of breath and chest discomfort. Removing the pleura can prevent further fluid accumulation and allow the lung to re-expand.
Another indication for a pleurectomy is spontaneous pneumothorax, where air leaks into the pleural space, causing the lung to collapse. For individuals experiencing repeated pneumothorax episodes, a pleurectomy can help prevent future lung collapses by allowing the lung to adhere to the chest wall.
A pleurectomy is also a treatment option for certain types of cancer affecting the pleura, particularly malignant pleural mesothelioma. This cancer develops in the lining of the lungs, requiring the removal of the pleura along with any visible tumors. This procedure, sometimes combined with decortication to remove fibrous tissue from the lung surface, aims to reduce tumor burden and improve breathing.
The Procedure Overview
A pleurectomy is performed while the patient is under general anesthesia. The surgeon selects a surgical approach based on the specific condition and its extent. Common methods include open thoracotomy or video-assisted thoracoscopic surgery (VATS).
In an open thoracotomy, a larger incision is made on the side of the chest, often between the ribs, to directly access the pleural space. Sometimes, a rib may be removed to create sufficient working room. This approach allows the surgeon a direct view and ample space to remove the affected pleura and any associated diseased tissue or tumors.
Alternatively, VATS is a less invasive technique where several small incisions are made. A thin tube with a camera, called a thoracoscope, is inserted through one incision to visualize the chest cavity on a monitor. Specialized instruments are then inserted through other small incisions to perform the pleurectomy. After the pleura is removed, chest tubes are placed to drain any remaining fluid or air and to help the lung re-expand fully.
Recovery and Post-Procedure Care
After a pleurectomy, patients remain in the hospital for several days, 7 to 15 days, depending on the surgical technique and individual recovery. During this time, pain management is provided. Patients may receive oxygen and fluids through an IV, and breathing exercises are encouraged to support lung function.
Upon discharge, a full recovery can take several weeks to months, with a return to daily activities often within 4 to 8 weeks. Patients are advised to avoid heavy lifting for about four weeks and gradually increase their activity levels. Wound care instructions are provided, and follow-up appointments are scheduled to monitor healing and overall progress.