Surgical Lung

Question 1

Indication for pneumonectomy

Answer 1

NSCLC (central tumour)
Tuberculosis
Trauma

Question 2

Indication for lobectomy

Answer 2

NSCLC - More peripheral tumours
Abscess
Localised bronchiectasis with recurrent haemoptysis
Lung trauma
Aspergilloma
Bullectomy

Question 3

Indication for VATS

Answer 3

Biopsy
Lung abscess resection
Surgical treatment of haemothorax
Recurrent pneumothorax (pleurectomy/ pleurodesis)
Bullectomy
Decortication
Wedge resection
Lobectomy (will have a larger scar that is absent in non lobectomy scar)

Question 3

Benefits of VATs over thoracotomy

Answer 3

Smaller incision
Reduced pain
Reduced wound complication
Reduced healing time
Reduced length of stay

Question 4

Scars in respiratory exam

Answer 4

Thoracotomy
VATs (3 scars in triangle)
- largest 3-6cm - access incision
- 2x for surgical instrumentation + thorascope
Mediastinoscopy
Midline sternotomy
Chest drain scars
Radiotherapy tattoo
Clamshell incision

Question 5

Indication for clamshell incision

Answer 5

Bilateral lung transplant (CF/ bronchiectasis/ pulmonary HTN)

Question 6

What happens to trachae/ breath sounds/ percussion in lobectomy vs pneumonectomy

Answer 6

Lobectomy - trachae may deviate towards, reduced breath sounds (unless many years ago and may have compensations with remaining lobes hyperinflating). percussion normal

Pneumonectomy - trachae WILL deviate towards side. breath sounds absent. percussion dull

Question 7

Post lung surgery follow up

Answer 7

Disease recurrence (lung cancer)
ensure remaining lung intact/ disease
Any evidence of COPD
Aid in smoking cessation

Question 8

Misleading signs on respiratory exam in pneumonectomy

Answer 8

May get bronchial breathing on side of lung removal (transmitted breath sounds form proximal airways)
Chest expansion - chest wall muscle may show exaggerated movements on side of pneumonectomy

Question 9

When may you see a thoracotomy scar

Answer 9

Pneumonectomy
Lobectomy
Single lung transplant
Some cardiac/ oesophageal procedures

Question 10

What is post pneumonectomy syndrome?

Answer 10

Occurs following a right pneumonectomy
Compression of distal trachae and main bronchus due to mediastinal shift due to hyperinflated lung
Tends to occur 6 months post op

Management is surgical repositioning of mediastinum and filling of post pneumonectotmy space +/- stenting of trachae