Surgery

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History of Thoracic Surgery

The surgical operation should start with bronchoscopy. Bronchoscopy, which can be done under local or general anesthetic, consists of passing a flexible tube down into the bronchial passages for a systematic examination. This examination is essential to assess the proximal extent of tumor, to rule out the presence of other tumors and to obtain cultures of bronchial fluids.

Following bronchoscopy, a special tube (Univent or double lumen endotracheal tube) is placed into the airway that allows the anesthesiologist to collapse the lung during critical parts of the operation and to provide safe ventilation of the lungs

. The chest is next entered through an incision between the ribs called a thoracotomy. It is usually a curved incision around the side of the chest, under the tip of the shoulder blade and the breast area. The muscles of the chest wall, and those between the ribs are then cut, and the ribs are spread apart with a retractor.

The surgeon next examines by direct vision and palpation (feeling with the hand), the entire chest contents, and decides on the extent of operation needed to completely remove the tumor. Sometimes needle or wedge biopsies of lung or other structures with examination of the tissues under the microscope by the pathologist (frozen section) will be needed in this determination.

The next step is dissection of the pulmonary arteries, veins and bronchi that supply the area of the lung to be removed. The arteries and veins are either tied or stapled and cut, and the bronchus is stapled or sewn over.

Finally, all lymph nodes in the root (hilum) of the lung and all of the nodes in the mediastinum should be dissected and removed.

Before closure of the chest, chest tubes are inserted between the ribs to collect blood, other fluid drainage and air from the chest.

Finally, the wound is closed and the patient returned to the recovery room.

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