Pneumonectomy

The following tests may be performed before a pneumonectomy:

1. Chest x-ray: This test helps the doctor to view the heart and lungs.
2. Chest CT scan: This is an imaging test done to obtain detailed images of the lungs.
3. Positron emission tomography (PET) scan: This procedure may be performed to look for cancer tissue.
4. Electrocardiogram (ECG): This test helps to check for the electrical activity of the heart.
5. Echocardiogram: Sound waves are used to evaluate the function of the heart, that is, how well the heart pumps blood.
6. Pulmonary function tests: These tests include spirometry and measuring the oxygen saturation of the blood to help in determining how well the lungs are functioning.
7. Ventilation-perfusion scan: This scan is done to check which areas of the lung contribute to breathing the most.
8. Blood tests: This test helps in checking the overall health of the patient.
9. Biopsy: A small section of the lung tissue is excised to check for cancer cells or other lung diseases that be present.

The procedure is normally done under general anesthesia (the patient is put to sleep during the procedure).
The procedure can be performed using any one of the following methods:

1. Video-assisted thoracoscopic surgery (VATS):
This is a minimally-invasive type of surgery.
The surgeon makes small cuts or incisions in the chest region.
The surgeon inserts special instruments and a thoracoscope, which is a thin, lighted instrument with a camera on one end, through these incisions.
The surgeon views the inside of the body on the monitor that is attached to the camera of the thoracoscope.
The surgeon can see the inside of the chest on the video screen while doing the surgery.
The diseased lung is then deflated and removed from the chest region.
The incisions are closed using sutures (stitches).
This procedure is less painful than open surgery, and also has a quicker recovery as compared to open surgery.

2. Open surgery (thoracotomy):
This is the most commonly performed procedure for pneumonectomy.
The surgeon makes a long incision between two ribs, on the side of the diseased lung.
The incision goes down from under the arm to around the back.
The two ribs are separated.
In some cases, a small part of the rib is removed for better access.
The diseased lung is deflated.
The pulmonary artery and vein (the main blood vessels that enter and leave the lung) are clamped and divided.
A part of the bronchus (a tube connecting the trachea or windpipe and the lung) may also be clamped and divided.
The surgeon then removes the diseased lung from the chest region.
The surgeon may also remove some nearby lymph nodes.
A temporary drainage tube is usually left in the pleural space (the cavity between the lungs and the area under the chest wall) from the area of lung removal to allow the drainage of fluid, air, and blood. This chest tube is removed once the condition of the patient improves.
The ribs, muscles, and skin are closed using sutures.
A dressing is applied over the incision.

The complications associated with a pneumonectomy are:

• Bleeding

• Blood clot formation in the lung (pulmonary embolism)

• Infection

• Allergic reaction to anesthesia

• Abnormal heart rhythm

• Fluid buildup in the space left behind after removal of the lung

• Collapsed lung (deflation of the lung causing difficulty in breathing, low oxygen in the blood, and chest pain)

• Air leakage into the chest between the chest wall and lung

• Movement of tissues and organs into the space left behind after the removal of a lung

• Respiratory failure (the inability of the respiratory system to give sufficient oxygen to the body and adequate removal of carbon dioxide from the body)

• Death

• You may wake up several hours after the procedure.
• Your vital signs will be carefully monitored.
• Small tubes may be temporarily placed in your nose to provide oxygen.
• Some amount of drainage from the incision is normally seen after the procedure.
• You may feel some soreness after the procedure.
• Your doctor may recommend pain-relieving medications to relieve your pain and discomfort.
• You will be having a temporary chest tube to remove the fluids, blood, and air from the chest area. 
• Compression stockings can be worn on the legs to prevent blood clot formation.
• You may need to stay in the hospital for a couple of days after the procedure.
• Your stitches will be removed in a follow-up appointment.
• You may feel tired easily. It may take many weeks before you recover your lost strength.
• Avoid heavy lifting and strenuous activities for 6 to 8 weeks after the procedure.
• Ask your doctor when it would be safe to resume driving.
• Follow your doctor’s instructions about medications, diet, wound care, and exercise.
• Contact your doctor if you notice any signs of fever, infection, swelling, or severe pain after the procedure.