Lung Surgery: Procedure, Types and Recovery

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2.Why is lung surgery performed?

Lung surgery may be performed for one of several reasons:

-To perform a biopsy of lung tissue in case, any abnormal growth is suspected

- To drain fluid build-up from the chest in a lung surgery procedure called pleurodesis

- To remove a part of the lung if it has been infected by cancer; the lung operation can be performed to remove a portion of the lung, an entire lung section known as alone or a complete lung. Breathing normally with one lung is possible.

- To drain blood from the chest cavity after trauma such as an accident

-To replace a lung in case, no other lung surgery procedure can give results

- To remove "pulmonary blebs" and prevent the collapse of the lung

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3.Conditions that require lung surgery

Conditions that require lung surgery are severe and will be performed by a highly trained lung surgeon to avoid any complications. The tissue is more fragile, and the infections or growth removed by the lung surgery procedure should not cause further damage to the organ. The surgery is performed for any of these pathologies if recovery through medication is not possible:

Bronchiectasis: Involves recurring infections in the bronchial regions. It may cause scarring or thickening of the bronchial wall and may reach a point of severity where the condition is no longer treatable by drug therapy. This condition causes patients to be highly fatigued, have bad breath, extreme coughing and cause eventual weight loss. Cystic fibrosis can also be an underlying cause of the condition. If the patient stops responding to antibiotics, a lung operation to remove the abnormalities or to drain the blockage regularly is suggested as a corrective measure.

Interstitial lung disease: Scarring of the lung tissue can cause extreme difficulty in breathing and may have underlying factors such as asbestosis, pneumonitis, connective tissue disorders or idiopathic pulmonary fibrosis. Lung surgery, and sometimes a complete lung transplant, is suggested by doctors in case the fibrosis is untreatable by breathing techniques or antibiotics.

Lung cancer: Cancerous tumours would require a biopsy to be performed, necessitating an initial lung surgery. In case the tumour is ascertained to be treatable by radiation therapy, a further lung surgery procedure may be avoided. However, a lung operation may be determined to be the best way forward for patients whose cancer has progressed beyond the initial stages. A pulmonology specialist can guide you to the most effective options in case of such a condition.

Lung nodules: These are benign growths on the lung tissue, which may not always require surgery. A lung operation will be recommended by doctors in case the nodule is found to be blocking airways and hampering the quality of patient life. The lung surgery success rate in case of such a procedure is relatively quite high and sees a patient living a more active life if the underlying cause of the nodule growth is addressed.

Blebs: They are small cavities where the air is trapped between the lung surface and its outer covering, and a rupture in a bleb can cause the lung to collapse in severe cases. In some patients, pulmonary blebs may form close together and fuse to create a "bulla". A lung surgery procedure to remove blebs or bullae helps prevent further complications and is done after administration of general anaesthesia.

Collapsed lung: It is a condition caused most often due to trauma resulting from a penetrating wound such as a fractured rib, a knife or bullet wound, and in rare cases, cigarette or drug abuse, or lung disease. The pneumothorax or lung collapse may be treated by a lung specialist without open surgery, in some instances, inserting a needle to remove air pressure and a chest tube. More critical cases involve lung operation and prevent immediate death in cases of extreme trauma. Pneumothorax may be a simple or tension pneumothorax, and the latter is immediately life-threatening and will require emergency care, often involving lung surgery.

Emphysema: The lung contains tiny air sacs called alveoli that help in inhalation and exhalation. Emphysema means that the alveoli are damaged and will weaken the lungs, causing a lack of sufficient oxygen and rapid breathing. It can occur without apparent symptoms, but if shortness of breath with unexplained fatigue is felt, it is best to consult a lung specialist who might suggest a type of lung surgery. Considering that lung surgery risks have reduced considerably in the last decade with precision instruments and robotic thoracotomy becoming more common, a lung operation help rid patients from a chronic condition like emphysema and provide a higher quality of life

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4.Types of lung surgery

The two major ways that lung surgery procedures are performed include:

Thoracotomy: A lung surgeon makes a cut in the chest wall to access the lung tissue that needs to be repaired or removed; this is a more traditional method and it’s also known as open surgery. It is an invasive procedure where the rib cage is separated or a rib is removed, and the entire procedure can take between 2 to 6 hours during which the patient is sedated under the influence of general anaesthesia.

Lung surgery recovery time after thoracotomy depends on the overall health of the patient and the procedure they've undergone, in addition to the underlying causes. After an open lung surgery, it is normal to spend about a week at the hospital under continued medical observation. It is also quite common to feel tired for 6-8 weeks after the lung surgery procedure is completed.

Video-assisted Thoracoscopy Surgery (VATS): This type of lung surgery procedure is designed to be less invasive than open surgery, and helps with quick recovery. A lung surgeon makes small incisions in the chest wall through which several tubes are passed, one of them being a video camera with high intensity light, to aid in the surgical removal of lung tissue. This lung surgery procedure is also known as keyhole surgery, due to the size of the incision made, as well as laparoscopic lung surgery, named after the camera device.

Usually, the recovery time is drastically reduced for a VATS procedure when compared to a thoracotomy since the wounds are smaller, and most patients observe that they can return to normal routines much more quickly after laparoscopic lung surgery.

These two processes can be used to remove all or some portions of a lung and can be classified as below:

Pneumonectomy: Removal of an entire lung that is irreversibly damaged either due to cancer or through scarring is known as a pneumonectomy. Removing an entire lung through a lung surgery procedure requires thoracotomy, and is used as an extreme measure after possibility of all other lung operations have been excluded. It is possible to live a normal life after a pneumonectomy with adequate rehabilitation.

Lobectomy: Human lungs are made up of 5 sections, with the left lung having 3 sections called lobes, and the right lung having 2 lobes. A lobectomy lung surgery procedure involves a lung surgeon sectioning off and removing one of the lobes of the lungs to ensure that no airways are blocked, or so that cancer does not spread to other parts of the lung and the body.

A lung surgery procedure involving the removal of two lobes from the lung is also known as bilobectomy. This may involve removal of lobes from both lungs.

Wedge resectioning: This lung surgery involves removing a portion of the lung when a lobectomy is ruled out. Usually used to remove tumors, the wedge resection procedure involves sectioning off of a portion of a lung lobe that carries that cancerous growth, instead of the entire lobe. However, the chances of the cancer returning with a wedge resectioning procedure is higher than that of a lobectomy.

Segmentomy: This type of lung surgery involves the removal of certain portions of the lung with the blood vessels such as veins and arteries passing through them, without removing a complete lobe or wedge.

Sleeve resectioning: If the cancer is growing on or near the bronchial tubes, the lung surgeon will section off the affected part and reconnect the tube through this lung surgery procedure.

Lymphadenectomy: A lung surgeon may remove lymph nodes from the lung area if they suspect the possibility of cancer in them. This lung surgery procedure reduces the possibility of recurring cancer and is most often followed by radiation therapy.

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5. Are you the right candidate for lung surgery?

Most lung disorders do not require lung surgery. As a patient with respiratory problems, you may be provided with courses of antibiotics, pain medication or recommended breathing techniques to ease your discomfort. However, it is best to consult with a lung specialist in case of recurring wheezing, shortness of breath at rest, coughing up of blood and fatigue resulting from heavy breathing that does not ease with medication or therapy. Especially in cases of minor patients, a paediatric pulmonologist must be consulted to determine the best way forward.

Only a small percentage of patients with lung disorders and cancer are recommended for lung surgery. Depending on lung function, type of disorder / cancer, location of the tumor, lung surgery history of patient and family, type of cancer and stage of metastasis, a patient may be declared as a candidate for lung surgery. To determine if you can have a lung operation, it is best to visit a lung hospital with trained specialists who perform pre-surgical evaluation to determine if you’re suitable for the lung surgery procedure.

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6.How do I prepare for lung surgery?

Depending on your suitability as a lung surgery candidate, you may be asked to undergo pulmonary rehabilitation to ensure that your lungs are in a condition as healthy as possible, and this will also include quitting smoking. Smoking damages the lung and prolongs lung surgery recovery time and may lead to further complications. A pulmonologist at a specialized lung hospital will also be the best consultant to ensure that you do not take medication that may further damage the lungs or cause complications, such as blood thinners. A rehabilitation prior to surgery will also involve regular exercise that helps your lungs become healthier and improves circulation.

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7.Complications and risks that might arise

The complications from lung surgery procedures commonly involve pain (which is managed by medication) and the following factors as well:

Air leaks: If an airway is inadvertently damaged during the lung surgery procedure, an air leak that is not completely closed, becomes a serious complication
Damage to surrounding areas: An incision on a blood vessel, such as a major artery or vein, or too an undamaged part of the lung can happen. This is a very rare situation, however, and it can be treated by a lung surgeon who is highly specialized and comes with experience in lung surgery
Infections: These are a more common risks and with some varieties of superbugs becoming immune to medications, sterilization during the lung surgery procedure has to be completely ensured
Low tolerance / Allergies to anaesthesia: Since a lung operation is performed under the influence of general anaesthesia, it is necessary to ascertain the patient will not face complications during surgery. This complication is most often ruled out during preoperative evaluation of the lung surgery candidate.

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8.How do I recover from lung surgery?

Lung surgery is an invasive procedure and recovery from the operation takes time. It is common to feel symptoms like:

Fatigue: This is a common lung surgery after effect and the patient may feel a sense of lethargy stemming from extreme fatigue. Combating this will require adequate nutrition and sometimes a lung surgery recovery diet is suggested, along with frequent naps and a restriction on too much traveling.

Shortness of breath: While lung surgery should essentially ease this symptom, it may become necessary to consult with a pulmonologist if this persists after surgery. Relaxation and deep breathing techniques will help in the meantime.

Skin reactions and hair fall: They can be side effects from drugs that are taken after lung surgery. It is necessary to keep in touch with the speciality hospital as you recover to ensure that symptoms do not lead to further complications.

Throat and mouth pain: Soreness in the throat region leading up to the mouth may occur during recovery. This symptom will ease with time; the patient will be provided with a lung surgery recovery diet that includes nutritious but soft and more moist food items would aid to reduce lung surgery recovery time.

Lung surgery recovery requires patience and time, but it is possible to live a healthy and active life after the lung surgery procedure has been undergone. Certain precautions aid with quicker recovery for patients who have undergone lung operation.

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9.Precautions to take after lung surgery

Precautions after lung surgery are not very difficult to implement, and they will definitely help reduce the lung surgery recovery time. These include simple measures such as getting adequate rest, discipline with regards to regular exercise and diet, quitting smoking and removing yourself from the proximity of smokers and smoke, and regular follow ups at a ung hospital.

More frequent naps become necessary for many patients, for 2-6 months after lung surgery, and this may require a major lifestyle change such as moving jobs. The correct medication can manage any occurrences of pain, so ensure that you receive the right dose. A lung surgery recovery diet designed by a nutritionist specializing in lung disorders would help the body recover the necessary nutrition and restore vitality. Gastrointestinal issues that arise after lung surgery can be avoided, if precaution toward food intake is maintained.

Most often, rehabilitation after lung surgery is guided by doctors in the hospital where the patients undergo lung surgery procedure, and this ensures that any recovery program is personalized by taking into consideration each patient's unique condition. This will also include teaching the patient breathing techniques, that has to be followed after the surgery, and physiotherapy programs.

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10. Lung surgery FAQs: All your concerns addressed

Q. Do non-smokers get lung cancer?

It is not common for non-smokers to be affected by lung cancer, but there are several causes apart from smoking that have been known to cause cancer of the lungs. Besides lung cancer, there are several lung disorders that might make lung operation a requirement for future well-being and it is best to consult with a pulmonologist or a specialist at a lung hospital to determine if you are a candidate who requires lung surgery, if you are affected by any of the symptoms that accompany lung disease.

Q. Why would I need a lobectomy?

Lobectomy or bi-lobectomy is most commonly performed if lung cancer is diagnosed at an early stage and a lung surgeon determines if the cancer can be completely removed through sectioning off of a lobe of the lung. It may also be performed in cases of severe infections such as tuberculosis and complicated fungal infections, or abscesses and scarring that may block airways.

Q. What are the different types of Lung Surgery?

Wedge resection (segmentectomy) - It is the removal of a small wedge-shaped piece of lung that contains lung cancer tumour and a margin of healthy tissue around it as a precautionary measure. The risk of recurring lung cancer is higher in this method.
Lobectomy - The left lung has two lobes and the right lung has three. In Lobectomy, an entire lobe of your lung that contains the cancer is removed. Your lungs are completely capable of functioning with the remaining lobes.
Pneumonectomy - In this type of surgery, the entire lung that contains the lung cancer is removed. A pneumonectomy is done very rarely as it will greatly reduce your overall lung function.
Sleeve resection - The cancerous part of the bronchus is removed. The bronchus is the part of the trachea (windpipe) that branches off into each side of the lungs.
Some other common lung surgeries or procedures are:
- Biopsy of an unknown growth
- Lobectomy, to remove one or more lobes of a lung
- Lung transplant
- Pneumonectomy, to remove a lung
- Surgery to prevent the buildup or return of fluid to the chest (pleurodesis)
- Surgery to remove an infection in the chest cavity (empyema)
- Surgery to remove blood in the chest cavity, particularly after trauma
- Surgery to remove small balloon-like tissues (blebs) that cause lung collapse (pneumothorax)
- Wedge resection, to remove part of a lobe in a lung
- A thoracotomy is a surgical cut that a surgeon makes to open the chest wall.

Q. How is lung surgery performed?

Lung surgery using a thoracotomy is an open surgery procedure. In this surgery, the patient needs to lie on the side on an operating table, with the arms placed above the head.
The surgeon makes a surgical cut between two ribs. These ribs will be removed and separated safely. The lung on this side is deflated during surgery so that air will not move in and out of it. This makes it easier for the surgeon to operate on the lung.
Depending on the patient’s condition, the surgeon decides what type of surgery is required. After the surgery, the surgeon closes the ribs, muscles, and skin with sutures. Open lung surgery usually takes from 2 to 6 hours.

Q. How long does it take to recover from a lung operation?

Usually, for the next 6 to 8 weeks after surgery, the patient needs to take proper care. The chest may hurt and be swollen for up to 6 weeks. It may ache, feel stiff, tightness, itching, numbness, or tingling around the cut (incision) the doctor made for up to 3 months.
For a smooth recovery after lung cancer surgery, follow all the restrictions made by the doctor, do rest but walk for some time every day and eat according to the prescribed diet. The patient might also have to supplement the diet with supplements if recommended.

Lung Surgery:
A guide to the procedure, risks and recovery

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1.What is lung surgery?

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