Removal of parts or the Entire lung for tumour or infection (Pulmonary Resection)

The lungs are organs of the respiratory system, located on either side of the heart within the chest cavity. The right lung has three lobes and the left lung has two lobes. Their function is to transport oxygen from the air into the blood and remove carbon dioxide from the blood. Pulmonary resection or lung resection refers to the surgical removal of a portion of a diseased lung or the entire lung.

Indications

Pulmonary resection is indicated for the following conditions:

Cancer or other benign growths in the lung
Lung diseases such as emphysema (gradual damage to the lung’s air sacs)
Lung infections such as tuberculosis
Atelectasis (collapse of lung)

Types of Pulmonary Resection

There are different types of pulmonary resection depending upon the underlying disease and the amount of lung to be removed.

Wedge Resection: refers to the removal of a small wedge shaped section of the lung along with a small portion of the surrounding healthy tissue. This procedure is generally used for early-staged lung cancer, when the abnormality or disease involves a small area of the lung tissue.
Lobectomy: is the most commonly performed surgical procedure that involves the removal of one entire lobe of the lung.
Pneumonectomy: refers to the removal of an entire lung. It greatly reduces the overall lung function and is recommended only for patients whose heart and lung function is sufficient to tolerate a pneumonectomy.

Surgical Procedure

Pulmonary resections can be performed traditionally through open surgery or advanced minimally invasive surgical technique. Both techniques are performed under general anaesthesia.

Open Surgery: During an open surgery, your surgeon makes one long incision between the ribs, below your armpit on the side of the infected lung. The ribs are separated and a portion of a rib may be removed to provide a better view and access to the lung.

Video-assisted Thoracoscopic Surgery: With technological advancements, minimally-invasive surgical techniques such as the video-assisted thoracoscopic surgery has been developed where your surgeon is able to view and access the chest cavity with 2 to 3 small incisions made on the chest region. Through one of the incisions, your surgeon inserts a thoracoscope (a thin tube attached to a video camera). The camera is connected to a television monitor to help your surgeon view the operating site. Your surgeon then inserts specially designed surgical instruments through the other incisions in order to perform the resection.

Following the exposure of the diseased lung, the lung is temporarily collapsed. The entire lung or the portion of the diseased lung is removed. A flexible tube is inserted into the chest cavity (chest tube) to drain air and/or fluid postoperatively. The procedure is completed by examining the chest cavity, re-inflating the remaining lung and closing the incisions using stitches or staples.

These minimally invasive procedures are preferred when they are an option as they greatly reduce your hospital stay, pain, recovery time and risk for infection.

Complications

Like all surgical procedures, pulmonary resection may be associated with certain complications such as:

Hemothorax: blood accumulates in the pleural cavity
Chylothorax: lymphatic fluid accumulates in the pleural cavity
Persistent air leakage due to small injuries in the pleura
Bronchopleural Fistula: abnormal passage that develops between the cut bronchus and pleural cavity
Post-pneumonectomy Empyema: pus in the pleura
Atelectasis
Pneumonia: infection in the lungs
Pulmonary Oedema: fluid accumulation in the lungs
Post-pneumonectomy Syndrome: shifting of the organs in the chest cavity towards the vacant space left by the excised lung

Post-operative Care

Following the surgery, you will spend 5 to 7 days in the hospital, or 2 to 3 days if a minimally invasive technique is performed. During this time, you will be given pain relieving medicines and will be connected to a ventilator to help you breathe. Once the ventilator is removed, you will be asked to cough in order to clear the airways, and taught breathing exercises to prevent infection and inflammation. After discharge, you are advised against driving for a week, lifting heavy weights and other strenuous activities. You are encouraged to continue your breathing exercises and start mild physical activity like walking for better blood circulation and muscle strength. You should avoid exposure to irritants like tobacco smoke, fumes and pollution, and others experiencing cold or flu symptoms.

You should call your doctor immediately in case you develop the following symptoms after a pulmonary resection:

Shortness of breath or difficulty breathing
Increased redness, pain, drainage, or swelling around the incision site
Yellow, green or blood-tinged sputum
Chest pain
Fever
Pain in your calves which may be due to blood clots