thoracic surgery

• Thoracotomy


  Surgical incision of the chest wall
• Lateral thoracotomy


  • Incision between the ribs at the side of the chest
  • Chest is difficult to get into from this point of entry and rib retractors are necessary
  • Open the pleural cavity
  • Can do some cardiac procedures
  • Can do biopsies
• Thoracoscopy


  • Uses a scope to view the pleural space
  • Can then remove small objects, perform lung biopsy
• Medial sternotomy


  • Used most frequently for cardiac surgery
  • Can access the pericardium with out entering the pleural cavity
  • Wired after surgery because less movement
  • Infection in this region can be severe
  • Infection may need debridement
• Thoracoplasty


  • Removal of ribs resulting in the reduction of lung volumes in that area of the chest
  • Used for TB – not often done
  • Removes "rib hump" after spinal surgery to fix scoliosis
• Pleurodesis


  • An irritant (bleomycin, tetracycline, or talc powder) instilled between the pleura in order to create inflammation; this tacks the two pleura together
  • Prevent recurring pleural effusion
• Bullectomy


  • Lung reduction
  • Removes blebs in order to let functional lung to expand
• Thoracentesis


  • Needle aspiration done under CT scan
  • Risk of lung collapse
• Pulmonary resection procedures


  • Wedge resection
  • Segmental resection
  • Lobectomy
  • Pneumonectomy
• Wedge resection


  • Removal of a small wedge shaped localized area near the lung surface
  • Done for cancer or biopsy
• Segmental resection


  • Removal of one or more segments
  • Indication for the procedure include tuberculosis, bleb, localized abscess, or bronchiectasis
• Lobectomy


  Removal of a lobe
• Pneumonectomy

  • One entire lung is removed
  • Done if major bronchi must be removed or if significant tissue is involved
  • Can only be performed is a patient has good lung function
• Complications of thoracic surgery

  • Bleeding
  • Atelectasis: higher risk with upper abdominal and thoracic surgery
  • Subcutaneous emphysema
  • Pulmonary infections: post surgery bronchial hygiene and expansion therapy are important