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Lobectomy- Lung
Depending on the lobe of the lung that is being removed, the different types of lung lobectomies are:
- Left upper lobectomy: It is the removal of the left lung’s upper lobe.
- Left lower lobectomy: It is the removal of the left lung’s lower lobe.
Purpose: A lobectomy is performed in the following cases:
- Bronchiectasis: A condition in which there is scarring and widening of the lung airways.
- Lung cancer: A type of cancer that begins in the lung.
- Benign tumor: It is a non-cancerous type of lung growth.
- Congenital cystic adenomatoid malformation: It is a non-cancerous mass of abnormal lung tissue present at birth.
- Lung blebs: These are large blisters in the lung that can lead to their collapse.
- Fungal infections: The fungal type of lung infections that are resistant to less invasive forms of treatment can be treated by lobectomy.
- Pulmonary sequestration: It is an abnormal type of lung tissue that does not function normally and usually develops before birth.
- Tuberculosis (TB): It is a chronic bacterial infection affecting the lungs.
- Lung abscess: It is an area of pus that may be formed in the lung.
- Emphysema: It is a type of chronic illness that occurs due to the breakdown of the elastic fibers in the lungs and makes it harder for the lungs to move on breathing.
The following diagnostic tests may be performed before a lobectomy procedure:
- Blood tests and urine tests: These are routine tests performed to check for underlying medical conditions.
- Chest x-ray: It helps the doctor to check the condition of the organs in the chest region.
- Electrocardiogram (ECG): This test helps the doctor to check the electrical activity of the heart.
- Imaging tests: Tests like x-rays and CT scans help the doctor to obtain images of the lungs and check for the presence of cancer.
- Ventilation/perfusion scan: This is a type of imaging test done to check how much of the lung can be safely removed.
- Bronchoscopy: It is a procedure in which a tube having a camera at its lower end is inserted through the mouth and throat and into the bronchi and lungs to check for the presence of any pathology.
- Pulmonary function tests: These tests are performed to check the functional capacity of the lungs.
The surgery is usually performed under general anesthesia (the patient is put to sleep during the procedure) and can be performed in the following different ways:
1. Open surgery or thoracotomy:
A long incision is made at the side of the chest.
The ribs are spread apart to easily visualize the diseased lobe and remove it.
2. Video-assisted thoracic surgery (VATS):
Two or four small incisions are made on the side of the chest.
A tube with a tiny video camera is used to look inside and guide other surgical tools.
This procedure is less painful and has a quicker recovery than open surgery.
3. Robot surgery:
The surgery is performed by robotic arms that are being controlled by the surgeon by looking at the monitor.
The procedure is performed by making three to four small incisions between the ribs.
The procedure has lesser bleeding, faster recovery, and lesser chance of infection compared to the other two techniques used.
The complications associated with a lobectomy procedure are:
- Infection
- Bleeding
- Allergic reaction to the anesthetic agent used
- Pneumothorax (lung collapse due to the air in the space between the lung covering, known as the pleural space)
- Empyema (pus area in the chest cavity)
- Pleural effusion (fluid in the space between the lung and inner chest wall)
- Bronchopleural fistula (a tube-like opening between the bronchus or airway and pleural space leading to the leakage of fluid or air into the chest area)
- Heart problems, like abnormal heart rhythm or a bleed around the heart
- You will stay in the recovery room for some time after the surgery, where your vital signs will be monitored.
- A chest x-ray may be performed immediately after the surgery to check if the lungs are fine.
- You will be given painkillers to provide relief from pain and discomfort after the procedure.
- You will be staying in the hospital for many days after the surgery.
- You will have one or more chest tubes near the incision area to drain the fluid and air from the chest region. These tubes are removed before you are discharged from the hospital.
- You will be taught coughing techniques and deep breathing exercises to help the lungs in re-expanding after surgery. This aids in breathing and prevents pneumonia.
- Oxygen supply may be needed for some time after surgery.
- You need to keep the incision clean and dry.
- Your doctor will give you bathing instructions.
- It is normal to feel some soreness in the surgical areas for a few days after the surgery.
- It is normal for your shoulder muscles and chest to pain after surgery, especially during coughing, physical activity, or deep breathing.
- The sutures or staples will be removed by the doctor in a follow-up appointment.
- Avoid heavy lifting and strenuous activities for a few months after the surgery.
- Avoid exposure to chemical fumes and environmental pollution.
- Quit smoking.
- Avoid contracting upper respiratory tract infections like cold and flu.
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Lobectomy- Lung
Depending on the lobe of the lung that is being removed, the different types of lung lobectomies are:
- Left upper lobectomy: It is the removal of the left lung’s upper lobe.
- Left lower lobectomy: It is the removal of the left lung’s lower lobe.
- Right upper lobectomy: It is the removal of the right lung’s upper lobe.
- Right middle lobectomy: It is the removal of the right lung’s middle lobe.
- Right lower lobectomy: It is the removal of the right lung’s lower lobe.
- Bilobectomy: It is the removal of two lobes of the lung.
- Sleeve lobectomy: It is the removal of a lobe, as well as a part of the bronchus (air passage into the lung).
Symptoms
Purpose: A lobectomy is performed in the following cases:
- Bronchiectasis: A condition in which there is scarring and widening of the lung airways.
- Lung cancer: A type of cancer that begins in the lung.
- Benign tumor: It is a non-cancerous type of lung growth.
- Congenital cystic adenomatoid malformation: It is a non-cancerous mass of abnormal lung tissue present at birth.
- Lung blebs: These are large blisters in the lung that can lead to their collapse.
- Fungal infections: The fungal type of lung infections that are resistant to less invasive forms of treatment can be treated by lobectomy.
- Pulmonary sequestration: It is an abnormal type of lung tissue that does not function normally and usually develops before birth.
- Tuberculosis (TB): It is a chronic bacterial infection affecting the lungs.
- Lung abscess: It is an area of pus that may be formed in the lung.
- Emphysema: It is a type of chronic illness that occurs due to the breakdown of the elastic fibers in the lungs and makes it harder for the lungs to move on breathing.
Diagnosis
The following diagnostic tests may be performed before a lobectomy procedure:
- Blood tests and urine tests: These are routine tests performed to check for underlying medical conditions.
- Chest x-ray: It helps the doctor to check the condition of the organs in the chest region.
- Electrocardiogram (ECG): This test helps the doctor to check the electrical activity of the heart.
- Imaging tests: Tests like x-rays and CT scans help the doctor to obtain images of the lungs and check for the presence of cancer.
- Ventilation/perfusion scan: This is a type of imaging test done to check how much of the lung can be safely removed.
- Bronchoscopy: It is a procedure in which a tube having a camera at its lower end is inserted through the mouth and throat and into the bronchi and lungs to check for the presence of any pathology.
- Pulmonary function tests: These tests are performed to check the functional capacity of the lungs.
Treatment
The surgery is usually performed under general anesthesia (the patient is put to sleep during the procedure) and can be performed in the following different ways:
1. Open surgery or thoracotomy:
A long incision is made at the side of the chest.
The ribs are spread apart to easily visualize the diseased lobe and remove it.
2. Video-assisted thoracic surgery (VATS):
Two or four small incisions are made on the side of the chest.
A tube with a tiny video camera is used to look inside and guide other surgical tools.
This procedure is less painful and has a quicker recovery than open surgery.
3. Robot surgery:
The surgery is performed by robotic arms that are being controlled by the surgeon by looking at the monitor.
The procedure is performed by making three to four small incisions between the ribs.
The procedure has lesser bleeding, faster recovery, and lesser chance of infection compared to the other two techniques used.
Risks
The complications associated with a lobectomy procedure are:
- Infection
- Bleeding
- Allergic reaction to the anesthetic agent used
- Pneumothorax (lung collapse due to the air in the space between the lung covering, known as the pleural space)
- Empyema (pus area in the chest cavity)
- Pleural effusion (fluid in the space between the lung and inner chest wall)
- Bronchopleural fistula (a tube-like opening between the bronchus or airway and pleural space leading to the leakage of fluid or air into the chest area)
- Heart problems, like abnormal heart rhythm or a bleed around the heart
After Procedure
- You will stay in the recovery room for some time after the surgery, where your vital signs will be monitored.
- A chest x-ray may be performed immediately after the surgery to check if the lungs are fine.
- You will be given painkillers to provide relief from pain and discomfort after the procedure.
- You will be staying in the hospital for many days after the surgery.
- You will have one or more chest tubes near the incision area to drain the fluid and air from the chest region. These tubes are removed before you are discharged from the hospital.
- You will be taught coughing techniques and deep breathing exercises to help the lungs in re-expanding after surgery. This aids in breathing and prevents pneumonia.
- Oxygen supply may be needed for some time after surgery.
- You need to keep the incision clean and dry.
- Your doctor will give you bathing instructions.
- It is normal to feel some soreness in the surgical areas for a few days after the surgery.
- It is normal for your shoulder muscles and chest to pain after surgery, especially during coughing, physical activity, or deep breathing.
- The sutures or staples will be removed by the doctor in a follow-up appointment.
- Avoid heavy lifting and strenuous activities for a few months after the surgery.
- Avoid exposure to chemical fumes and environmental pollution.
- Quit smoking.
- Avoid contracting upper respiratory tract infections like cold and flu.
FAQ Section
The lungs are two large organs in the chest cavity and are divided into lobes, with right lung having three lobes and left lung has two. The function of the lungs is to transfer and filter oxygen and move it into our blood. The lungs also defend us from harmful elements like smoke, pollution, bacteria, and viruses. They trap and partly kill these substances in mucus made by the lungs. This mucus is then expelled from the body by coughing and/or swallowing. A lobectomy is the removal of part of a lung. A lobectomy is a surgery performed under general anesthesia during which an entire lobe of the lung is removed.
A lobectomy may be used to treat some cases of:
- Emphysema.
- Fungal infection.
- Lung abscess.
- Lung cancer.
- Non-cancerous tumor.
- Tuberculosis (TB).
A lobectomy is performed using an operation that is used to gain access to the chest cavity in order to do larger, or more complex operations. The procedure involves an incision approximately 4 to 6 inches long, located beneath the armpit, or behind the shoulder blade. An opening is created between your ribs in order to allow the surgeon to see well inside your chest, and to use special instruments inside the chest. Once all the lobes are identified, they are ligated and divided. The lobe containing the cancer is then dissected away from the other lobes and is removed. After the lobe is removed, there is some empty space inside the chest. That empty space is reduced naturally by the body. The remaining lobes on the operated side expand slightly, the diaphragm muscle moves upward, and the center of the chest moves over to help fill the empty space. In addition, the surgeon will leave 1 or 2 chest tubes (drains) in the chest for several days to assist in removing any extra air and any extra fluid.
Thoracotomy: An incision is made between two ribs, from the front of the chest around to the back and the lobe is removed through this incision.
Video-Assisted Thoracic Surgery (VATS): Small incisions are made, in which the surgeon inserts a thorascope (tube with a camera attached), which allows the surgeon to see inside your chest and is less invasive than undergoing a thoracotomy.
A lobectomy is the surgical removal of a lobe of the lung and is the most common surgery performed to treat lung cancer and has been traditionally performed during thoracotomy surgery.
Lobectomy is major and complicated surgery and is performed under general anesthesia.
A lobectomy is most usually used to remove lung cancer. But, other suggestions for lobectomy include fungal infections, lung abscess, localized bleeding from the lung, infected cavities in the lung, pulmonary infarction, and others. An entire lobe of the lung is usually removed even when treating relatively small lung cancer. This is done in order to remove not only cancer itself but also the surrounding lymph nodes. Therefore, both cancer and the surrounding lung tissue containing the lymph nodes are removed.
Risks include the usual risks of surgery including infection, bleeding, possible transfusion, pneumonia, reaction to anesthesia, prolonged use of mechanical ventilation (breathing machine), prolonged air leak, lung collapse, empyema, damage to nearby organs including the heart, heart attack, and stroke.
Most patients spend 1 night in the intensive care unit and then the patient is transferred to a normal hospital room with cardiac monitoring. Most patients remain in the hospital for 5 to 7 days. Often times, a temporary chest tube may be placed to remove extra fluid or/and air. Pain control is very important and at the time of discharge, the patient will have adequate pain control by use of pain pills.
A. The surgical removal of a portion of the lung, called a lobe, affected by a disease is known as lobectomy.
A. The different types of lung lobectomies, depending on the lobe of the lung being removed include:
- Left upper lobectomy: It involves the removal of the left lung’s upper lobe.
- Left lower lobectomy: It involves the removal of the left lung’s lower lobe.
- Right upper lobectomy: It involves the removal of the right lung’s upper lobe.
- Right middle lobectomy: It involves the removal of the right lung’s middle lobe.
- Right lower lobectomy: It involves the removal of the right lung’s lower lobe.
- Bilobectomy: It involves the removal of two lobes of the lung.
- Sleeve lobectomy: It involves the removal of a lobe, as well as a part of the bronchus (air passage into the lung).
A. The following conditions may indicate the need for a lobectomy:
- Tuberculosis (a type of bacterial infection that may affect the lungs)
- Lung abscess (an area of pus formed in the lung)
- Benign (non-cancerous) growth
- Lung cancer
- Emphysema (a chronic illness that makes lung movement harder during breathing)
- Fungal infection
A. Lobectomy may be performed by a thoracic surgeon or general surgeon.
A. The following diagnostic tests are performed before a lobectomy surgery:
- Blood tests and urinalysis: These are routine tests performed before a surgery to check for the various blood parameters, as well as the presence of any underlying medical conditions.
- Chest x-ray: This test helps the doctor to check the condition of the heart and lungs.
- Electrocardiogram (ECG): It helps in evaluating the electrical activity of the heart.
- Imaging tests: Imaging tests such as x-rays and CT scans help the doctor to obtain clear images of the lungs and checking for the presence of cancer.
- Ventilation/perfusion scan: This type of imaging test is performed to check how much of the lung can be safely removed.
- Bronchoscopy: This procedure involves the insertion of a tube with a camera at its lower end through the mouth and throat and into the bronchi and lungs. It helps the doctor to check for the presence of any pathology.
- Pulmonary function tests: These tests help in checking the functional capacity of the lungs.
A. The following preparation may be done before a lobectomy procedure:
- If the patient has any medical conditions, inform the doctor about the same.
- If the patient is currently taking any supplements, medications, or herbs, tell the doctor about the same.
- If the patient is allergic to any medications, anesthetic agents, iodine, latex, or tape, inform the doctor about the same.
- Stop smoking as soon as possible.
- The doctor will tell the patient to stop blood-thinning medications like warfarin and aspirin a few days before the procedure.
- The patient should avoid eating or drinking anything after midnight, the day before the surgery.
A. The lobectomy surgery is normally performed under general anesthesia (the patient is made unconscious before the procedure). The surgery may be done in the following different ways:
1. Open surgery or thoracotomy:
- A long incision is made by the surgeon at the side of the chest.
- The ribs are spread apart to easily view and remove the diseased lobe.
2. Video-assisted thoracic surgery (VATS):
- Two or four small incisions are made by the surgeon on the side of the chest.
- A tube with a tiny video camera is used to view inside and guide the other surgical tools.
- This procedure is less painful and has a more rapid recovery than open surgery.
3. Robot surgery:
- This is an advanced type of surgery that is performed using robotic arms that are being controlled by the surgeon.
- This procedure is done by making three to four small incisions between the ribs.
- This procedure has lesser bleeding, quicker recovery, and lesser chance of infection than the other two techniques being used.
A. The following are the post-procedure steps after a lobectomy:
- The patient stays in the recovery room for some time after the surgery, where the vital signs of the patient are monitored.
- A chest x-ray is done immediately after the surgery to check if the lungs are working fine.
- The patient is given painkillers to provide relief from pain and discomfort after the procedure.
- The patient needs to stay in the hospital for several days after the surgery.
- The patient has one or more chest tubes placed near the incision area to drain the fluid and air from the chest area. These chest tubes are removed before discharge from the hospital.
- The patient is taught coughing techniques and deep breathing exercises. This helps the lungs to re-expand after surgery, aids in breathing, and prevents pneumonia.
- Oxygen supply may be given to the patient for some time after surgery.
- The patient needs to keep the incision clean and dry.
- The doctor will provide the patient with bathing instructions.
- It is normal to have some soreness in the surgical areas for some days after the surgery.
- The shoulder muscles and chest may have some pain after surgery, especially during coughing, deep breathing, or physical activities.
- The sutures or staples are removed by the doctor in the follow-up appointment.
- The patient should avoid strenuous activities and heavy lifting for a couple of months after the surgery.
- The patient should avoid exposure environmental pollution and chemical fumes.
- The patient should quit smoking as soon as possible.
- The patient should take precautions to ensure that he/she does not get any upper respiratory tract infections like cold and flu.
A. In cases of early-stage non-small cell lung cancer, lobectomy has the best long-term survival. In cases of stage I and stage II lung cancer, the 5-year survival rate is between 40 and 70%.
A. The complications associated with a lobectomy procedure are:
- Bleeding
- Infection
- Allergic reaction to the anesthesia used
- Pneumothorax (lung collapse due to air in the pleural space, which is the space between the lung covering)
- Bronchopleural fistula (fluid or air leakage into the chest due to a tube-like opening between the bronchus and pleural space)
- Empyema (an area of pus in the chest cavity)
- Pleural effusion (presence of fluid in the space between the lungs and inner chest wall)
A. The cost of lobectomy varies depending on the technique used for the procedure, the type of lobectomy performed, and the overall health of the patient.
The cost also varies among different doctors in different hospitals. Normally, the cost of lobectomy in India is between INR 1,50,000 to INR 3,00,000.