LUNG SURGERY

Mr Pick’s Heart & Lung Practice has developed a novel approach to thoracic surgery, in order to offer the least invasive procedure, and minimise post-operative pain.

The lungs lie within the chest cavity, under a lining that covers the lungs and another that lines the rib cage. These linings, or pleura, slide over each other as the lungs exchange gases with the air as we breathe (a pleural space). The right lung has three lobes and the left lung has two lobes. The lung to be operated on is deflated in surgery, and a breathing tube helps the other lung continue to function. The patient is comfortably positioned on their side after the induction of general anaesthetic.

What is thoracoscopy, thoracotomy, and a thoracic access port?

A standard thoracotomy is an incision which is approximately 30cm long and requires the use of retractors to separate the sternum or ribs to obtain access to the lungs. Mr Pick does not perform thoracic surgery through a thoracotomy. Instead, Mr Pick gains access to the lungs through a thoracic  port, a  5-6cm long incision which is made in the space between the ribs under the arm pit, where a lady’s bra strap would normally sit.

A thoracoscopy port is a small incision, 1cm across, where a long scope with an illuminated camera is inserted into the chest. Mr Pick uses the video-assisting thoracoscopic surgery (VATS) technique, through strategically placed thoracoscopy sites to view the lungs and perform the surgery through the thoracic access port. The technique is muscle sparing and is non-rib spreading, which means a retractor is not used. This minimises pain and speeds patient recovery.

To reduce the number of punctures to the patient, the thoracoscopy ports are where the drain tubes are threaded through at the completion of the procedure, into the pleural space. Fluid and air accumulate in the chest cavity and have to be drained post operatively. The tubes are removed after a short interval, a few days at the very most. To minimise post operative pain, Mr Pick will usually insert an extra pleural catheter which bathes the intercostal nerves with anaesthetic solution for 48 hours, and often eliminates the need for additional IV or oral painkillers.

Lobectomy, wedge resection, segmentectomy and pneumonectomy

Patients usually present to Mr Pick because they have had a chest x-ray which shows an abnormality in the lung. The nodule or lesion may be suspicious for malignancy. This may be because the patient has risk factors for malignancy such as a long smoking history, or they have had a PET scan that has shown areas of high metabolic activity, suggestive of malignancy.

Mr Pick aims to cure our patients of lung cancer with surgery and our practice has experienced great success in doing so. There are factors considered when  choosing an operation for a patient: sometimes a pathologist is present in the operating theatre and a specimen is taken for biopsy, the immediate results of which determine how much of a patient’s lung has to be removed in order for the patient to be cancer-free. A spirometry (lung function) test is almost always performed prior to surgery, to assess a patient’s lung performance, to determine how much lung is needed for adequate lung function.

Wedge resection or Segmentectomy

A small wedge-shaped piece of a lobe of a lung is taken, removing the nodule or lesion and a small margin of normal tissue. This may be done because lung function would be compromised to remove the entire lobe. The risk of recurrence of lung cancer is higher with this procedure.

Lobectomy

A lobectomy is the removal of the entire lobe of a lung. Mr Pick may take a biopsy, and then determine whether to proceed to lobectomy while the patient is anaesthetised.

Pneumonectomy

This is a radical procedure where the entire lung is removed. Lung function will almost certainly be affected significantly in this instance.

Sleeve Lobectomy

A lobe of the lung is removed along with the part of the bronchus that attaches to the lobe. The bronchus is reattached to the remaining adjacent lobe of the lung, enabling more lung to be preserved.

Lymphadenectomy

At times, some of the lymph nodes near the lungs are removed for biopsy for staging for malignancy.

Possible incision sites for VATS

Risks of Surgery

Due to the minimally invasive technique, the risks and side effects that are generally associated with the procedure are drastically reduced. You won’t experience pain as would normally be associated with lung surgery, and your recovery time will be expedited. Risks associated with thoracotomy that may also occur include: bleeding, infection, an air leak in your lung (albeit infrequently) that does not close, damage to your heart, lungs, blood vessels or nerves in the chest, ongoing chest wall pain, inflammation of the lungs – pneumonia, as well as risks from general anaesthesia such as nausea, vomiting, headache, blood pressure issues or allergic reaction.