Types of Thoracic surgery by Nursesnote

 Thoracic Surgery

Exploratory thoracotomy

Description: Internal view of lungs

• Usually posterolateral parascapular but could be anterior incision.
• Chest tube after procedure.

Indications

• May be used to confirm carcinoma or for chest trauma ( to detect source of bleeding).

Lobectomy

Description: Lobe removal

• Thoracotomy incision at site of lobe removal
• Chest tube after procedure.

Indications

• Used when pathology is limited to one area of lung: bronchogenic carcinoma, giant emphysematous blebs or bullae, benign tumors, metastatic malignant tumors, bronchiectasis and fungal infections.

Pneumonectomy: 

Description: Removal of an entire lung

• Posterolateral or anterolateral thoracotomy incision
• Sometimes there is a rib resection.
• Normally no chest drains or tubes because fluid accumulation in empty space is desirable.

Indications

• Performed chiefly for carcinoma, but may be used for abscesses, bronchiectasis, or extensive tuberculosis. Right lung is more vascular than left; may cause more physiologic problems if removed.

Segmentectomy 

Description: Only certain segment of lung removed.

• Segments function as individual units.

Indications

• Used when pathology is localized ( such as in bronchiectasis) and when the patient has preexisting cardiopulmonary compromise.

Wedge resection

Description: Small localized section of lung tissue removed usually pie-shaped.

• Incision made without regard to segments
• Chest tubes after procedure.

Indications: 

• Performed for random lung biopsy and small peripheral nodules.
• Considered when less invasive tests have failed to establish a diagnosis.
• May be used as a therapeutic procedure.

Thoracoscopy

Description: Direct visualization of pleura with thorascope via an intercostal incision.

• Medical under sedation or local anesthesia; allows for visualization and biopsy.
• Video assisted thorascopic surgery (VATS) under general anesthesia; multiple puncture sites and video screen allow for visualization and manipulation of the pleura, mediastinum, and lung parenchyma.

Indications

• VATS may be used for lung biopsy, lobectomy, resection of nodules, repair of fistulas.

Decortication

Description: Removal or stripping of thick fibrous membrane from visceral pleura.

• Use of chest tube drainage system postoperatively

Indications

• Empyema unresponsive to conservative management

Thoracotomy not involving lungs

Description: Incision into the thoracic cavity for surgical procedure on other structures.

Indications

• Used for hiatal hernia repair, open heart surgery, esophageal surgery, tracheal resection, aortic aneurysm repair.

Lung volume reduction surgery (LVRS)

Description: Involves reducing lung volume by multiple wedge excisions or VATS.

Indications

• Performed in advanced bullous emphysema, ∝1-antitrypsin emphysema.