Definition & Overview
The human lungs have several lobes, with the right lung typically having three while the left one having two. If one or more of these lobes no longer function normally, the doctor would recommend a lung lobe removal procedure, a major surgery called pulmonary lobectomy, to prevent further complications.
There are several types of pulmonary lobectomy depending on the number and location of the lobes to be removed. These include bilobectomy (the removal of two lobes), left upper lobectomy, and right lower lobectomy.
Who Should Undergo & Expected Results
A pulmonary lobectomy is used to treat:
- Lung cancer (to prevent its spread to other organs and parts of the body)
- Tuberculosis that does not respond to medications
- Lesions or blisters in some parts of their lungs
- Emphysema or fungal infection (if no other medical treatment or recourse is possible)
In rare instances, pulmonary lobectomy is also performed on infants who are diagnosed with congenital cystic adenomatoid malformation (the presence of a noncancerous mass of lung tissue at birth) or pulmonary sequestration (the presence of abnormal lung tissue before birth).
Following surgery, the patient is placed in intensive care unit for at least a day before being transferred to a hospital room. Recovery is gradual, taking weeks or even months. Patients are given medication to manage pain, as well. To help the lungs recover and regain function, patients are also required to undergo physical therapy. The outcome of this procedure depends on several factors, including age and general health status of the patient, as well as the severity of the condition.
How Does the Procedure Work?
The procedure starts with the administration of anaesthesia.
There are two major ways of performing a lung lobe removal. One is the traditional method or open surgery called thoracotomy, in which the surgeon makes a large incision in the chest. The ribs are pulled apart to locate and remove the diseased or abnormal lobe.
Alternatively, the surgeon could also decide to make several small incisions in the chest area to insert small surgical tools with a camera. This minimally invasive procedure is called video-assisted thoracoscopic surgery (VATS) and is considered less traumatic compared to thoracotomy.
The surgeon also ties off the blood vessels going to and from the affected lobe. Tubes are then placed inside the chest to drain any fluid or remove extra air that might accumulate in the area. The incisions are closed using stitches or surgical staples.
In some instances, it is possible for a surgeon to perform thoracotomy even if the patient has already undergone VATS to ensure the success of the procedure.
Possible Complications and Risks
Those undergoing a major surgical procedure would always face several potentially life-threatening risks. These include adverse reaction to anaesthesia, internal bleeding, blood clotting, or bacterial infection. There is also the possibility of blood infection, called septicemia.
Despite the presence of drain tubes in the chest, fluid buildup in the lungs can still be a major concern. This is why patients are closely monitored for several days after surgery. The space left by the procedure could also cause leakage of air into the area between the lungs and chest wall. A collapsed lung is also a possibility, leading to respiratory failure and even death.
Some patients also report the development of abnormal heart rhythm following pulmonary lobectomy as well as changes in lung functions.
Putnam JB Jr. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 58.
Tsiouris A, Horst HM, Paone G, Hodari A, Eichenhorn M, Rubinfeld I. Preoperative risk stratification for thoracic surgery using the American College of Surgeons National Surgical Quality Improvement Program data set: Functional status predicts morbidity and mortality. J Surg Res. 2012: epub ahead of print.