Our lungs are a pair of spongy organs located in our rib cage.
Oxygenated blood is pumped by the heart to circulate throughout the body. Meanwhile, oxygen and nutrients found in the blood are taken up by tissues and the blood with low oxygen concentration flows back to the right heart and finally pumped to the lungs.
Oxygen concentration of blood is increased in our lungs and the wastes of the body mechanism are excreted in the form of carbon dioxide.
The right lung has three lobes, while the left lung is divided to two lobes. These lobes are also divided into pulmonary segments.
The blood vessels of lungs are named according to this structural segmentation. Common pulmonary artery carries the dark or venous blood to lungs, while the oxygenated blood flows to the left ventricle through the common pulmonary vein; the vasculature of lungs is called as lobar, bronchial and segmental arteries and veins. A lung segment is a unit with own artery, vein and bronchus.
Lung resection can be carried out to treat pathologies that involve lungs, lung cancers, infections such as bronchiectasis or to collect biopsy specimens from the lung tissue.
Primary lung cancer implies cancers that originate from own tissues of lungs. As the dark or venous blood is completely oxygenated and detoxified in lungs, a tumor that develops in another organ can probably spread to lungs through the blood circulation or close proximity. This type of cancers is called secondary or metastatic lung cancer.
For lung cancers, surgery is preceded by a number of treatment options, including but not limited to chemotherapy, radiotherapy and targeted treatment.
If criteria of surgery can be met, such as removal of tumor and ability to survive with the rest healthy lung after the tumor is surgically removed, thoracic surgeon may consider or recommend resection of lung for the treatment of lung cancer.
For other pathologies that require resection of lungs, the principal criterion is whether the rest healthy lung will be sufficient for survival.
For lung resection, a segment, a lobe, two lobes or the whole lung can be resected or surgically removed and a wedge-like part of the lung is removed (wedge resection). Excluding wedge resection, all options are commonly referred to as anatomic resection.
Thoracotomy implies the open surgery carried out for lung resection. If technical means or patient and disease factors (location and spread of the condition) allow, minimally invasive surgery, videothoracoscopic surgery and robotic surgery are other options.
As thoracotomy offers the best exposure, a long incision is made at level of the fifth rib and lungs are exposed.
All lung resections are major surgeries and therefore, the patient should be very carefully prepped. Review of health history is followed by a comprehensive physical examination. Blood tests are planned in the light of signs and symptoms as well as physical examination data. Moreover, advanced imaging studies, such as CT, MRI and PET/CT, are ordered to visualize stage and spread of the condition and to plan the surgery.
Moreover, the patient is assessed by anesthesiologist in order to manage anesthesia-related risks and extra examinations are ordered, if required.
For lobectomy, the patient is transferred to the operating suite and an intravenous access line is inserted. A sedative agent is infused through this IV line to relax or calm down the patient. A tube is inserted to the throat of the patient in order to maintain breathing during the surgery. After anesthesia is administered, the patient is placed left lateral decubitus position, if the right lung is resected, or the patient is placed right lateral decubitus position, if the left lung is resected.
If open surgery (thoracotomy) will be carried out, an incision, measuring approximately 25 cm in length, is made at level of the 5th rib at the relevant side and lungs are exposed.
Small incisions are made for videothoracoscopic and robotic surgeries and ports are inserted through the incisions. While a camera is inserted through one of these ports, other ports serve insertion of surgical tools into the chest cavity.
After lobectomy, bilobectomy, pneumonectomy (removal of right or left lung completely) or wedge resection is carried out, two drains are placed, one in the apex of the lung and the other at the base. These drains function to drain fluid and blood and/or air that may accumulate in the body after the surgery.
Finally, the large or small incisions are stitched and closed with wound dressing.
Lobectomy – Bilobectomy: Lobectomy implies removal of a whole lobe of the lung due to a lung pathology or primary or metastatic cancer. As there are three lobes (upper, middle and lower lobes) are present in the right lung, bilobectomy refers concomitant removal of the middle lobe or lower or upper lobe. Thoracotomy is the open surgery method; however, if technical means or patient and disease factors (location and spread of the condition) allow, minimally invasive surgery, videothoracoscopic surgery and robotic surgery are other options. Thoracic surgeon determines the best method regarding the patient and the condition by reviewing all criteria.
Lobectomy is a major surgery and the artery that feed the lobe and the vein that drains the dark blood in the lobe are tied and cut/divided. Next, the bronchi of the lobe are similarly cut and the ends are closed. The lobe is dissected off the adjacent tissues and the nearby lobe.
A cavity develops in the chest cavity after lobectomy operations, but it is filled in as the rest lobe(s) will expand.
Segmentectomy: Lobes of lungs are divided into units, called segment. A lung segment is a lung unit with own artery, vein and bronchus. Ten segments are present in the right lung, while there are 8 segments in total in the left lung. Segmentectomy is the most minor one of the anatomic resections. The basic principle is to tie and cut the artery, the vein and the bronchus of the segment, occlude the end that is left inside the body and to dissect off and remove the segment completely.
Pneumonectomy: Pneumonectomy refers to total removal of right or left lung. It is largely preferred for patients with lung cancer, who fulfill necessary criteria. In case of pneumonectomy, patients should be far more closely monitored and fluid intake and electrolytes should be very carefully monitored and managed.
Wedge resection: It implies anatomic resection of lungs. This method is preferred for lung biopsies or removal of lesions located at the periphery of lungs. The periphery of lungs is removed in the form of wedge or “V”.