Thoracic Surgery: Pneumonectomy & Lobectomy Flashcards
What kind of incision for a pneumonectomy?
Thoracotomy
What are the indications for a pneumonectomy?
Carcinoma
Preoperatively we need know the patient will be able to tolerate one lung removal and we will assess this via the following:
- Exercise testing with SaO2 monitoring
- Pulmonary function tests
Pulmonary function tests are one of the ways we assess the patient is able to tolerate one lung removal. What are the pulmonary function tests?
- FEV1 > 2L (associated with less than 5% mortality)
- FEV1 / FVC % > 50%
- VO2 Peak of less than 15ml/kg indicates a high risk for pneumonectomy
How many chest drains for a pneumonectomy?
1 chest drain
For a pneumonectomy, to ensure the bronchial stump remains intact, the patient must NOT ….
Must NOT lie on the good side
The chest drain is clamped and released how often to control the mediastinal shift for a pneumonectomy?
Released one minute every hour to control mediastinal shift
The chest drain is removed after how long for a pneumonectomy?
After about 24 hours and the mediastinal space is allowed to slowly fibrose
What happens that maximises the expansion of the remaining lung for a pneumonectomy?
The mediastinal shifts towards the operated side and the diaphragm moves upwards
Incision for a Lobectomy?
Thoracotomy. Some surgeons now performing video assisted thoracoscopic lobectomy (VATS)
Indications for a Lobectomy?
Usually Carcinoma, Bronchiectasis, Lung Abscess
A lobectomy on the right lung, what lobes are most often resected?
Middle and lower lobes due to their common lymph drainage
What kind of suction is chest drains on after lobectomy?
Low grade suctioning
Basal drain after a lobectomy is removed after how long?
1-2 days post op
The apical drain is removed when after a lobectomy?
When air leak ceases, usually 4-5 days post op
