Glossary of thoracic operations
Here
is a brief description of some chest operations. Your team
will advise you on the specifics of your own surgery.
'VATS' refers to video-assisted thoracic surgery, sometimes
called 'keyhole' surgery. This uses cameras and special
equipment to avoid making large cuts in the chest wall or spreading
of the ribs. A 'thoracotomy' is the standard open approach to the
chest..
Lung resections
The lung is divided into lobes (two on the left, three on
the right). A lobectomy involves removal of an entire lobe. This
has traditionally been achieved via a thoracotomy but is now often
performed by VATS (keyhole) techniques Usually, lymph
glands from the hilum (root) of the lung and middle of the chest
will also be removed at the same time. This is the standard
operation for lung cancer provided that the whole tumour can be
removed.
This is the removal of an entire lung. The risk of the operation
and the chances of breathlessness after surgery are higher than for
lobectomy, although both are very dependant upon your own state of
health before surgery. For this reason, it is usually
reserved for tumours where a lobectomy will not remove the entire
cancer.
Each lobe of lung is divided into segments. Segmentectomy
involves the removal of one segment. It is 'lung-preserving'
surgery and can be performed for lung cancer in patients who are
not fit for a complete lobectomy.
This is the removal of part of the lung, usually using a
stapling device. It is often performed to diagnose lung masses seen
on a CT scan, to remove tumours which have spread from elsewhere in
the body (known as metastases), or sometimes to treat lung cancer
in patients who are not thought fit enough to undergo a lobectomy
operation. Although often performed with the VATS technique,
but it can sometimes require a thoracotomy (open) incision.
Other lung operations
- Lung volume reduction surgery
A very select group of patients with severe emphysema may
benefit from this surgery. The aim is to remove redundant lung
tissue. This allows the lung tissue that remains to re-expand. The
mechanics of breathing may be improved. Thorough investigation and
treatment, usually including smoking cessation, medical treatment
and physiotherapy will take place before any surgery.
Diagnostic procedures and bronchoscopy
The surgical bronchoscope is
different from the flexible fibre-optic scopes used by physicians.
It is a long rigid tube that is passed into the trachea (windpipe)
under general anaesthetic. It enables visualisation of the airway
and allows procedures such as biopsy and stent placement (to hold
open a diseased airway) to be performed. Bronchoscopy is often
performed as a day case.
Enlarged lymph nodes in the chest can be biopsied using an
instrument called a mediastinoscope. A small incision is made over
the trachea (windpipe) in the neck and the scope passed into the
chest. Results will usually take several days.
Mediastinoscopy is often performed as a day case.
A small incision made over the second rib (usually the left) in
order to biopsy lymph nodes or tissue in the mediastinum (middle of
the chest) or at the hilum (root) of the lung.
In patients with suspected interstitial lung disease (an
inflammatory or scarring disease of the lung tissue) a lung biopsy
can help plan medical treatment. Biopsies are taken under general
anaesthetic, usually using a VATS approach.
Biopsy (sampling) of the pleura is performed to investigate
collections of fluid in the pleural space (pleural effusion), or
thickening of the pleura. It is often combined with
pleurodesis- the use of irritant material to create pleural
adhesions- to prevent fluid collecting around the lung again after
surgery. This surgery is often performed using VATS
techniques.
Operations for pneumothorax or collapsed lung
Pneumothorax is the collapse of a lung, usually caused by air
leaking from it. This can happen spontaneously, particularly
in young people. It may also happen because of underlying
lung disease, for example emphysema. Smoking increases the risk of
many of these diseases.
There are several ways to treat pneumothorax, with different
advantages and disadvantages. When surgery is advised, it
often includes removal of weakened areas of the lung (called bullae
or blebs) if present, together with a procedure to "stick" the lung
to the chest wall. This can be achieved by stripping the
pleura to create a raw surface, known as pleurectomy, or by using
an irritant substance to induce inflammation, called
pleuredesis. Talcum powder specially prepared for the purpose
has been used for many years.
In Bristol most of this surgery is now undertaken using VATS
techniques. Your own team will be able to discuss the options
with you.
Developing a pneumothorax may affect flying and scuba diving in
the future. If this affects you, please discuss it with your
team.
Surgery for myasthenia gravis
Patients with myasthenia gravis (a disease characterised by
progressive muscle weakness on repetitive use) often benefit
symptomatically from removal of the thymus gland. Surgery is more
successful if the patient is young with an early diagnosis.
In Bristol we perform a radical thymectomy via a neck incision
(trans-cervical approach) with VATS techniques. This enables a
quick recovery and often just an overnight stay in hospital.
If you have myasthenia gravis you will need to discuss with your
neurologist whether a thymectomy is appropriate for you.
