Lung Surgery

What is it?

Lung surgery generally involves the removal of part or all of one lung. A lobectomy is the removal of one lobe of one lung while a pneumonectomy is the removal of the entire lung. A wedge resection is removing part of one of the lobes, usually for smaller nodules/spots or cancers.

There are 3 lobes in the right lung and 2 lobes in the left lung. Lung Image

Why?

The most common reason for removing part of the lung is cancer. Sometimes, there may be a 'mass' or 'tumour' or 'nodule' that is very suspicious and it should be removed to determine what it is and at the same time treat it.

Preoperative Evaluation

Lung surgery is major surgery. You will need to undergo several tests before surgery in order to make the procedure as safe as possible. You may require some or all of the following:

Blood tests
Electrocariogram (ECG)
Pulmonary function tests (breathing tests)
CT scans (or CAT scans)
Bone scan
Ultrasound
Lung needle biopsy
Bronchoscopy
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You will also be assessed before surgery in the Pre-Admission Clinic, Zone C Level 2, to ensure all necessary procedures have been completed.

Procedure

The surgery is done through an incision ('cut') between your ribs on the side and back of your chest. Occasionally, a portion of a rib is removed. Sometimes, the procedure is done using small incisions. A video camera and surgical instruments are inserted through the small incisions and a portion of the lung removed. The amount of lung removed depends on the size and location of the tumour.

Time

The procedure takes between 3 and 5 hours and is done in the Operating Room at Victoria Hospital. You will need to register in the Admitting Department at London Health Sciences Centre's (LHSC) Victoria Hospital located in Zone D Level 3, at least 2 hours before your scheduled operation.

Risks

As with all major chest surgery there are risks. The surgical risks include bleeding, infection, heart attack, irregular heart beats, stroke, blood clots to the lung and sometimes death.

Before Your Procedure

DO NOT EAT OR DRINK ANYTHING, including water, after midnight the night before surgery unless instructed otherwise by your surgeon. Leave jewellery and valuables at home. Ensure that you tell the staff if you are taking any 'blood thinners' or other medications. You will be directed to the Day Surgery Unit located in Zone D Level 2, where you will be assessed by a nurse and have an intravenous started. To help prevent blood clots from forming in your legs during and after the surgery, sequential compression stocking may be applied.

Family and Friends

Family and friends may wait in the Perioperative waiting room located in Zone D Level 2, room D2-100. Your surgeon will come to speak with them following the procedure, so it is advisable for them to wait there.

After Surgery

You will wake up in the post anesthesia care unit (P.A.C.U. or 'recovery room'). A breathing tube may be in your mouth to help with your breathing. Once you are awake and able to breathe on your own, the breathing tube will be removed and you will be transferred to the Thoracic Observation Unit. If you need more help with your breathing, you will be transferred to the intensive care unit (C.C.T.C.) Zone D Level 2. While in the Thoracic Observation Unit, your heart rhythm and oxygen level will be monitored closely along with the drainage from your tubes. You will have many tubes. Some will be coming from your chest (chest tubes), your bladder (catheter), your arms or neck (intravenous lines). Most patients will also have an epidural in their back for pain control. These tubes will be removed over the next few days. You may eat and drink immediately after surgery. To help prevent blood clots from forming in your legs, you may be given a blood thinner injection daily.

Pain

There is moderate to severe pain with this surgery. A variety of methods are used to control pain. You may receive an epidural which delivers pain medication directly around the spinal cord, or an intravenous that you control to give yourself medication, a patient controlled analgesia (PCA) as needed. Many of these are started in the operating room to help decrease the pain immediately after surgery.

Physiotherapy

You will be seen by the thoracic physiotherapist who will help you with deep breathing, coughing, and getting out of bed. Walking after surgery is very important.

Discharge

Once all of the tubes are removed, you should be ready to go home. The average length of stay is 3-7 days. If the surgery is done using smaller incisions, the length of stay is typically shorter.

You must go home with either a friend or relative by private vehicle or by taxi, NOT by public transportation. Most patients do NOT need home care support.

Dressings

A bandage will cover the sites where the chest tubes were. This bandage should be kept dry and left in place for 2 days. After 2 days, remove the bandage and gently wash the wound with mild soap in the shower. Do not take a bath until all of the wounds are healed. Further dressings are not needed, but you may cover the would with a dry gauze if there is any drainage from it.

Activity

You are encouraged to do your regular activities except:

No heavy lifting for 6 weeks
Do not drive a car for 2 weeks

Prescriptions

You will be given a prescription for pain medications and a stool softener to prevent constipation. Additional prescriptions will be given if needed.

Follow-Up

Before you leave the hospital, your nurse will schedule a return appointment with your surgeon. This will be in approximately 6 weeks time. The final pathology results will be discussed during this appointment.

Call your surgeon's office if:

You have any excess:
- Bleeding
- Drainage from the wound
- Pain
- Shortness of breath
- Yellow or green sputum

You have a temperature of 38.5° C (101.50° F).
Your prescription runs out.
You have any questions.

Thoracic Surgery