LUNG SURGERY

IS THERE A PROBLEM WITH YOUR LUNGS?
Your doctor might have told you that you need lung surgery. Some lung problems can only be treated with surgery and you may also need additional procedures after surgery.

WHAT IS LUNG SURGERY?
Surgery is often done to get a closer look at the inside of the lungs and to help treat lung problems. There are two procedures for lung surgery: Thoracoscopy and thoracotomy. Your surgeon will choose the method that’s best for your specific condition.

Thoracoscopy: That uses a tube containig a camera, video monitor and several small incision.
Thoracotomy: This method needs a larger incision and surgeon is able to see your lung directly.

DO I HAVE ANOTHER TREATMENT OPTION?
Your doctors will give you more information about why you need lung surgery. Full information will be given you about operation and recovery period. Your surgeons will also give you other options for treatment as well. If you have questions or concerns, be sure to ask your surgeon at the time of the doctor visit.

WHAT ARE NORMAL LUNGS?
It is important to understand the anatomy of normal lungs to see how lung surgery may help. There are two lungs in your chest and these are further divided into sections which are called lobes. There are two lobes in the left and three lobes in the right lung. Air flows through tubes into your lungs called bronchi. Lobes have small sacs called alveoli which are responsible for oxygen-carbon dioxide exchange.

REASONS OF LUNG SURGERY?
Surgery is often done to get a closer look at the inside the lungs and to help treat lung problems. If you have a mass in your lung, surgery can help to identify the exact nature of the mass as well as to remove it. Lung surgery may be done for collapsed lung or fluid collection around the lung.

DO YOU HAVE A MASS IN YOUR LUNG?
If you have a mass in one of lungs or both, a biopsy may be useful to determine of nature of the mass. Benign (non- cancerous) or malignant (cancerous) masses can only be differentiated by biopsy. If the mass needs to be removed, it is important to know the size and exact location of the mass as well as if it has spread outside the lung. You may need removal of a part of or all of your lung which is called lung “resection”.

THE COLLAPSED LUNG:
In the case of rupture of a thin walled cavity (blebs or bullae) in you lung, air will leak out of the lung and will collect between the lungs and the chest wall: this situation is called “pneumothorax”. A tube is placed into chest cavity to treat this condition so air can be evacuated from the pleural cavity. This will ensure re-expansion of the lung. If the lung does not re-expand, you may need surgery to repair the defect in the lung tissue and stop the leakage of air outside the lung.

OTHER PROBLEMS WHICH MIGHT NEED LUNG SURGERY:
Sometimes there may be fluid collections around the lungs. This problem may occur as a result of infection. Fluid collection may also be seen after surgery or because of spreading cancer. A tube is placed into pleural cavity to drain fluid. Surgery may be required in the case of re-collection or to treat the infectious collections.

THE TESTS TO EVALUATE:
Your doctors may perform several tests to diagnose the condition in your lung. Some of these tests have to be done prior to surgery to help your surgeon evaluate the problem. After the results of these are available, your surgeons will make best treatment plan for your condition.

 Imaging tests for lung disease: Imaging tests will be done obtain detailed information regarding your condition. Lung masses, infections and pleural cavity can be examined by these tests. But imaging tests can’t tell whether a mass is benign or malignant. Imaging tests are chest X-rays, CT (computed tomography), MRI (Magnetic Resonance Imaging) and others. 

Direct Visualization:
These techniques allow direct examination and / or biopsy of your lungs.

Bronchoscopy uses a thin, lighted tube to examine airways. It is inserted through the mouth or nose.

Mediastinoscopy is a surgical procedure and is performed to evaluate the area between the lungs.
Needle biopsy may be needed to collect tissue or fluid through chest wall or through bronchoscopy.
Other Tests:
There are also other tests to evaluate how your lungs are functioning:

Spirometry can measure your lung capacity. It measures the functions of your lungs and determines if your lungs expand well or not.
Pulse oximetry measures the oxygen level in your blood.
Arterial blood samples show oxygen and carbon dioxide concentration in your blood.

TREATMENT OPTIONS FOR LUNG CANCER:
If your doctors determined the mass to be a lung cancer, they will explain your treatment options. Treatment will be planned according to location and stage of the cancer. Early stage lung cancer is usually localized to an area of your lung. In later stages, cancer may have extended to other parts of the lungs, to the lymph nodes or to other parts of body.Staging is important to determine the best treatment modality. 

There are three basic treatment methods for lung cancer:

Surgery: The goal is to try to eliminate the cancer with removing a part of or all of the lung.
Radiation therapy: The goal is to destroy cancer cells using high-energy X-rays.
Chemotherapy: The goal is control cancer cells with using medication.
THORACOSCOPY:
Thoracoscopy is used in situations described below:

To repair a collapsed lung
To make diagnosis of certain conditions of lung and the lining of the chest cavity.
To biopsy a suspicious mass in the lung or pleura
Staging a tumor known to be malignant
To drain fluid collections
Thoracoscopy is performed through small incisions in the chest wall. If visualization is poor or the condition cannot be approached safely using thoracoscopy, a thoracotomy (open surgery) may be necessary.

Preparing for Thoracoscopy:
You can ask your doctor any questions for your procedure. Stop smoking immediately if you are a smoker. Tell your doctors about your complete medication list. Do not eat or drink anything after midnight on the day of surgery. Be at the hospital exactly on the time you were instructed to.

Procedure:
This procedure is done under general anesthesia, which lets you sleep and ensures a completely pain-free procedure. Several small incisions are made in the chest wall. Surgeon inserts a thin tube containing camera through these small incisions. The camera is connected to as TV monitor for adequate visualization of the surgery by the surgical team. The procedure is completed through small incisions with the help of specialized instruments. One or more tubes may be temporarily placed in the chest to drain fluid and air. Ribs and incision are approximated securely at the end of the procedure.

Risks And Possible Complications:
Wound infection
Bleeding
Prolonged air leak from the lung
Pain or numbness at the incision site
Pneumonia
Recovering from surgery in the hospital:
Recovering from surgery in the hospital: You will be taken to the recovery room after surgery. You may feel some pain and maybe thirsty. Fluids and medications will be administered through the intravenous lines to keep you comfortable. A nurse or respiratory therapist will help you to exercise your lungs. You will be encouraged to walk as soon as possible.

After discharge:
At home, you will have to follow your doctor’s instructions. These are;

Take your medications for pain as prescribed.
Do the breathing exercises.
Walk as much as possible: this will regulate your blood circulation, prevent blood clots and strengthen your muscles.
Ask your doctor the time back to work.
When to call your doctor:
Shortness of breath, redness or drainage from the incision, sudden-sharp chest pain, fever over 38.3 degrees C, severe cough and thick sputum production.

THORACOTOMY (Open Lung Surgery): 
Thoracotomy is done via a larger incision on the side of the chest. This procedure provides better visualization of the lung and the area around lung. Your surgeon will give you the necessary information prior to the procedure.

Preparing for Lung Surgery: 
You will have some blood tests. If you a smoker, it is important to quit smoking immediately. You have to tell your surgeon about the complete medication list you are taking. Do not eat or drink anything after midnight on the day of surgery.

Anesthesia:
Your anesthesiologist will discuss the type of anesthetic medications and course of surgery prior to the procedure. These procedures are done under general anesthesia that will ensure to keep you comfortable during surgery. You may also receive another method called as “epidural anesthesia” that it will keep you painless during surgery and thereafter.

Risks and Possible Complications of Surgery: 
There are risks of general anesthesia itself, wound infection, bleeding, pneumonia, prolonged air leak from the lung, deep vein thrombosis, and pulmonary embolism.

SURGERY: 
The incision for this surgery will be on the side of the chest below your shoulder blade. After deflation of the lung by the anesthesiologist, the lung will be examined for any other pathology and the exact nature and extent of the problem will be determined. A part of your lung and most of the time lymph nodes in your chest will be removed. At the end of the surgery, one or more tubes will be placed in the chest cavity. The rib cage will then be closed securely.

Information for Family:
Procedure usually takes around 2 hours including preparation, the actual surgery and waking up in the recovery room. After surgery, your patient will be awakened in the recovery room. You should be able to see your loved one within a couple of hours after the surgery.

After Surgery: 
You will then be taken to the special care unit then to a regular room as you become more stable. You will have plenty pain medications to make sure that you are as pain-free as can be and comfortable. You will be asked to do some breathing exercises to improve your lung capacity and function. Hospital stay is usually a week or longer however it varies with each patient.

Early post-surgery period: 
You will wake up from general anesthesia and you may feel groggy, thirsty or cold. You will have some intravenous lines and tubes to give you pain medications or intravenous fluids. You may spend one or more days in the Intensive Care Unit, after which you will be taken to a regular patient room.

Recovery:
You will be asked to do breathing exercises to strengthen your breathing muscles and to improve blood circulation in your lungs. Taking your pain medications regularly will help you to be more comfortable doing these exercises. If you received an epidural pain catheter before surgery, it will remain in place for 2-3days and provide pain relief after surgery.

Pulmonary Support:
You will have to continue breathing exercises by your respiratory therapist to clear your lungs and ensure full lung expansion. Incentive spirometry is used to expand your lung capacity. After discharge from the hospital, you should continue these exercises for pulmonary support as well.

Going Home:
You will be given all the necessary instructions before leaving the hospital. Your doctors will also provide prescriptions for pain medications and other medications you might need at home.

During Home:
It is normal to feel tired soon after leaving the hospital. Breathing may be uncomfortable for a short period of time but you will get stronger in the course of time.

Taking care of your incision:
Your doctor will tell you when to take a bath. Wash your incision gently with warm water and soap and carefully dry it with a towel. It is normal that you may feel itching, soreness and observe bruising in the incision.

Medications:
You should take your medications as prescribed by your surgeons.

Activity for your normal life:
Do not carry any heavy bags for 6-8 weeks since it might put stress on your incisions. Walk as much as possible to improve your strength. Take your pain medications before exercise. As you begin to feel better, you can increase the amount of daily exercise.

When to call your doctor :
Call your doctor if you have:
Redness and drainage from the incision,
Sudden shortness of breath,
Sudden sharp chest pain,
Fever over 38.3 degrees C,
Rapid heartbeat
Looking Forward:
Diagnosis of cancer can cause additional stress. Tell your doctor about your concerns and feelings.

Your emotions:
It is very normal to feel depressed and anxious after surgery. You may feel energetic one day, then tired the next. Try not to feel withdrawn from your daily activities.

Following up with your doctor:
You should see your doctor for regular follow-up visits. During these visit, you may have new test to monitor your health.

For family:
Help your patient during this period. It is important to offer encouragement and equally important not to be overprotective.