Approaches to Lung Surgery

Lung surgery is a type of procedure that involves repairing or removing a portion of lung tissue. There are many different types of lung surgery, from minor excisions to whole-lung transplants. Here’s what you need to know about lung surgery. 

Key Facts

  • Lung cancer is one of the most common reasons to receive lung surgery, although it is also used to treat various other conditions, such as COPD and bronchiectasis.
  • Lung surgery is typically a major operation that involves general anesthesia and several weeks of recovery, although minimally invasive options exist that can shorten recovery time.
  • The outlook for lung surgery will depend on several factors, such as the condition being treated, how much lung tissue is being removed, and the patient’s overall health.

Purpose

In general, lung surgery is done to repair damaged lung tissue or remove significantly damaged or diseased areas. Lung surgery can treat various lung conditions, such as lung cancer, COPD, bronchiectasis, and more.

The following are some common reasons to have lung surgery:

  • Remove a blood clot
  • Remove a cancerous tumor
  • Remove damaged or diseased lung tissue
  • Remove an entire lung
  • Remove fluid build-up in the chest cavity
  • Repair collapsed lung tissue
  • Replace damaged lungs with healthy donor lungs

Procedure

There are many different types of lung surgery, depending on the condition. The following are the most common:

  • Lymphadenectomy: Removal of lymph nodes surrounding the lungs.
  • Wedge Resection: Removal of a small section of the lung, but not an entire lobe or segment.
  • Segmentomy: Removal of a segment of a lung, but not an entire lobe.
  • Lobectomy: Removal of one of the five lobes that make up the lungs.
  • Pneumonectomy: Removal of an entire lung.
  • Transplantation: Replacement of both lungs with healthy donor lungs.

While the specific procedures for each of these surgeries will vary, the two general methods that doctors use when performing them are thoracotomies and video-assisted thoracoscopy surgery (VATS).

Video-Assisted Thoracoscopy Surgery (VATS)

This type of surgery uses a small incision made in the chest to insert a camera and other tools. Because it is minimally invasive, it typically allows patients to recover quickly. However, it is not suitable for major operations, such as a pneumonectomy or transplantation.

The following is the general step-by-step procedure of a VATS:

  1. Preparation: The patient undergoes a physical exam and any other necessary tests to determine their eligibility for the surgery.
  2. Anesthesia: Just before surgery, an anesthesiologist will give the patient general anesthesia. This will put them into a deep sleep for the entirety of the operation.
  3. Incision: The surgeon will make several small cuts in the chest wall, then insert a small camera and other tools into them.
  4. Operation: When the camera and tools are in place, the surgeon will make repairs and remove the damaged area.
  5. Closure: After draining any excess fluid, the tools are removed, and the incisions are sewn shut.

Thoracotomy

This is the traditional method used for lung surgery. Also known as open surgery, it involves making a large incision down the chest wall and opening up the rib cage to access the lungs. It is a highly invasive procedure that will take several weeks or longer to recover from. 

The following is the general step-by-step procedure of a thoracotomy:

  1. Preparation: The patient undergoes a physical exam and any other necessary tests to determine their eligibility for the surgery.
  2. Anesthesia: Just before surgery, an anesthesiologist will give the patient general anesthesia. This will put them into a deep sleep for the entirety of the operation.
  3. Incision: The surgeon will make a six to eight-inch incision below the shoulder blades and between the ribs. Then they will separate the skin, muscle, and ribs to access the lungs.
  4. Operation: The lung being operated on is deflated so that air does not move it while the surgeon repairs or removes the damaged area. 
  5. Closure: The surgeon uses sutures to close the ribs, muscles, and skin.

Alternatives

Surgery remains the most successful method of repairing or removing damaged and diseased lung tissue. However, some patients may not be eligible for surgery. Depending on the condition and the health of the patient, the following are some possible alternatives:

  • Endobronchial Lung Volume Reduction Therapy: An alternative to lung volume reduction surgery, this procedure uses one-way valves to prevent air from inflating damaged portions of the lungs.
  • Radiofrequency Ablation: This is a minimally invasive procedure that uses heat to burn away and destroy cancerous and/or damaged tissue.
  • Stereotactic Body Radiation Therapy: A type of radiotherapy, this procedure uses targeted, high-dose beams of radiation to destroy cancerous and/or damaged tissue.

Nonsurgical treatment methods may also be a good alternative option.

Risks and Complications

Although advances in lung surgery and minimally invasive procedures have helped reduce risks and recovery times, it is still considered a major operation. The following are some general risks associated with lung surgery:

  • Bleeding
  • Blood clots
  • Damage to other organs
  • Infection
  • Nerve damage
  • Pain
  • Pneumonia

What to Expect Afterwards

The outlook and recovery times for lung surgery will vary depending on multiple factors, such as the condition being treated, the type of surgery, and the patient’s health. However, every patient should expect to go through a period of recovery following their surgery.

In general, patients will remain at the hospital from anywhere between one day and one week so doctors can monitor their condition and look for any possible signs of complications. Afterwards, they can return home to recuperate. It may take anywhere from several weeks to up to a year to fully recover from surgery. During this time, patients should follow up frequently with their doctor, eat a healthy diet, practice breathing techniques, and take any other necessary precautions.

Next Steps

We understand how intimidating the decision to get lung surgery can be. That’s why our experienced and multidisciplinary team of doctors, surgeons, nurses, and other health care professionals are ready to answer your questions. We will closely evaluate your condition and health, help create a treatment plan personalized for your needs, and work hard to put you on the path to recovery as quickly as possible. Even long after your surgery is over, we will remain in close contact with you to ensure your health and well-being over the long-term.

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-3408 for existing patients, (212) 304-7535 for new patients, or request an appointment online to get started today.

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