A wedge resection is a surgical procedure designed to remove a localized, triangle-shaped piece of tissue from an organ. This tissue-sparing technique focuses on eliminating a diseased area while preserving the maximum amount of healthy surrounding structure. It is a common procedure used across various surgical specialties when the target lesion is small and peripheral, aiming for a precise excision that minimizes the impact on organ function.
Defining the Procedure
The term “wedge resection” refers to the distinct physical shape of the tissue being removed: a triangular or V-shaped slice. Surgeons create this shape to ensure the target lesion, such as a tumor or nodule, is removed entirely, along with a small, clean margin of surrounding healthy tissue. This procedure is a prime example of parenchyma-sparing surgery.
This technique differs fundamentally from more extensive operations, such as a lobectomy or segmentectomy, which remove entire anatomical segments or lobes. In a wedge resection, the lines of excision do not necessarily follow the organ’s natural anatomical boundaries like fissures or vascular territories. The primary aim is to remove only the diseased portion, which is beneficial for patients whose overall organ function is already compromised.
Primary Medical Applications
Wedge resections are selected over more radical surgeries for two main reasons: diagnosis and therapeutic removal of small lesions.
For diagnostic purposes, the procedure is employed when imaging studies or less-invasive needle biopsies are inconclusive. Removing the entire lesion allows pathologists to analyze a larger, intact sample, leading to a definitive diagnosis.
Therapeutically, the procedure is frequently used to remove small, peripheral primary tumors or metastatic nodules, with the lung being the most common site. It is often the preferred option for patients with early-stage non-small cell lung cancer who have limited respiratory function, making them poor candidates for a full lobectomy. The technique is generally limited to lesions that are small (typically less than two centimeters) and located near the surface of the organ, such as in the liver and kidney.
The Surgical Process
The execution of a wedge resection uses two main approaches: open surgery or minimally invasive techniques. Open surgery, such as a thoracotomy for the lung, requires a larger incision for direct access and visualization of the organ. This method may be necessary for larger or more complex lesions, or in patients with significant scar tissue from previous procedures.
Minimally invasive approaches, including Video-Assisted Thoracoscopic Surgery (VATS) or robotic surgery, are increasingly preferred due to their reduced invasiveness. These techniques involve several small incisions (typically one to two centimeters) through which a camera and specialized instruments are inserted, transmitting a magnified, high-definition image to a monitor.
Once the lesion is identified, often using intraoperative ultrasound or palpation, the wedge of tissue is resected. Removal is accomplished using specialized surgical staplers that simultaneously cut the tissue and seal the remaining organ surface with multiple rows of titanium staples. These staplers ensure immediate hemostasis and an airtight closure, which is particularly important in lung tissue. The excised tissue is then retrieved through one of the small incisions.
Recovery and Post-Operative Care
The recovery process is highly dependent on the surgical approach used. Patients undergoing minimally invasive VATS or robotic surgery typically experience a shorter hospital stay, often two to four days. Open procedures, which involve a larger incision and rib spreading, require a longer inpatient stay for pain management and monitoring.
Pain management is a primary focus immediately following the procedure, often involving nerve blocks, patient-controlled analgesia, or epidural catheters. For lung procedures, a chest tube is commonly placed during the operation to drain fluid and air, allowing the remaining lung to fully re-expand. The tube is removed once the air leak has resolved and fluid output is minimal.
Patients are encouraged to begin walking and deep breathing exercises immediately to prevent complications. Restrictions on physical activity, such as lifting heavy objects or strenuous exercise, are advised for four to six weeks. Most patients can return to non-strenuous daily activities, such as light office work or driving, within two to three weeks of a minimally invasive procedure.