LECTURE NOTES ON PULMONARY RESECTION BY PROF MAHMOUD

LECTURE NOTES ON PULMONARY RESECTION BY PROF. MAHMOUD KHAIRY PROFESSOR OF CARDIOTHORACIC SURGERY

Def: operations done under general anaesthesia in which part or whole of the lung is removed. Segmental anatomy of the lungs. Indications Types Approaches complications

TYPES OF PULMONARY RESECTION ü Pneumonectomy and its variations: (pleuro-pneumonectomy, tracheal sleeve pneumonectomy). ü Lobectomy and its variations : (Bi-lobectomy, sleeve lobectomy) ü Segmentectomy ü Lesser resections: wedge resections, bullectomy, blebectomy, enucleation.

INDICATIONS OF PULMONARY RESECTION a) b) c) d) e) f) Congenital: congenital lobar emphysema, congenital adenomatoid cyctic malformation of a lobe. Inflammatory: bronchectasis, chronic nonresolving lung abscess, TB cavity or destroyed lobe or lung. Neoplastic: resectable lung cancer. Traumatic: severely lacerated lobe. Lung volume reduction surgery: in ttt of emphysema. In preparation for lung transplantation: in end stage lung diseases.

Congenital lobar emphysema Congenital cystic adenomatoid malformation

APPROACHES FOR PULMONARY RESECTION Thoracotomy: postero-lateral thoracotomy in lateral decubitus position, anterior thoracotomy in supine position, posterior peri-scapular thoracotomy in prone position, bilateral anterior thoracotomy with or without transverse sternotomy in bilateral lung transplantation. Video-assisted thoracic surgery (VATS) (thoracoscopy): Median sternotomy and parasternal approaches: very rare.

COMPLICATIONS OF PULMONARY RESECTION Early (30 days complications): v Acute postoperative respiratory failure, due to v Pain (postoperative analgesia; local + general, is mandatory). v Atelectasis & Pneumonia (chest physiotherapy, IV antibiotics, ? bronchoscopy). v Pulmonary oedema (restriction of IV fluids, diuretics, chest physiotherapy). v ARDS. v v v Cardiac arrhythmia (AF in patients > 60 ys). Bleeding. DVT, pulmonary embolism, Infections: empyema, wound infection and dehiscence. persistent air leak (visceral, disruption of bronchial stump causing bronchopleural fistula), Late: chronic pain, chronic respiratory failure, post- pneumonectomy syndrome.