1. 1 Chapter 32 Thoracic and Pulmonary Surgery

2. 2 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Review terms and definitions listed at beginning of chapter  Use your medical dictionary if necessary

3. 3 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lung function  Ventilation  Diffusion  Perfusion

4. 4 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Bronchi  Left and right primary  Branch off at the carina  Become bronchioles  Terminate at the alveoli

5. 5 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery Lungs and bronchial tree. (From Herlihy B, Maebius NK: The human body in health and illness, ed 2 Philadelphia, 2003, Saunders.)

6. 6 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lungs  Paired organs separated by the mediastinum  Enclosed in the pleural cavity  Covered by the pleural sac  Expand based on negative pressure created by the space between the two layers  Lung pressure  Break in integrity of pleural cavity causes a collapse

7. 7 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Mechanism of breathing. (From Herlihy B, Maebius NK: The human body in health and illness, ed 2, Philadelphia, 2003, Saunders.)

8. 8 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Diagnostic testing  Pulmonary function  Laboratory test  Imaging studies

9. 9 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Instruments  General surgery instruments  Chest wall instruments  Lung instruments  Bronchus clamps  Surgical stapling devices  Vascular clamps

10. 10 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery A. Thoracotomy instruments. Top, left to right: 1 malleable T retractor, 1 Giertz rib rongeur, 1 Matson rib stripper, and elevator. Bottom left: Burford rib spreader with shallow blade attached; 1 shallow blade; 2 deep blades. (From Tighe SM: Instrumentation for the operating room, ed 6, St Louis, 2003, Mosby.)

11. 11 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Chest Drainage System (From Lewis SM, Heitkemper MM, Dirksen SR: Medical surgical nursing, ed 6, St Louis, 2004, Mosby.)

12. 12 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Video-Assisted Thoracoscopic Surgery A, Trocar placement. B, Isolation of lung tissue. C, Insertion of endoscopic stapler. D, Resection of wedge. (Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)

13. 13 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Video-assisted thoracoscopic surgery  Patient position Lateral with an axillary roll  Anesthetic General  Trocar placement Dependent upon procedure

14. 14 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Thoracoscopy – Lung biopsy  Removal of a small portion of lung tissue for pathological examination  Performed when other diagnostic tests are inconclusive  Completed as a video-assisted procedure

15. 15 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lung volume reduction  Patients with chronic pulmonary emphysema may benefit Involves resection of portions of a lung in which air is trapped in emphysematous lung tissue

16. 16 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Bronchoscopy A, Top to bottom: Insertion of rigid bronchoscope. Endobronchial obstruction. Flexible scope is placed inside rigid scope for biopsy. B, Removal of mass using forceps. Laser removal. (From Sugabaker DJ, Strauss G, Fried MP: Laser resection of endobronchial lesions: Use of rigid and flexible bronchoscopes, Oper Tech Otolaryngol Head Neck Surg 3:93, 1992.)

17. 17 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Mediastinoscopy  Endoscopic examination of the mediastinum through incision  Thymus and lymph node biopsy are performed to establish a diagnosis

18. 18 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Thoracotomy  Open surgery of the thoracic cavity Thoraco = Chest cavity Otomy = Incision into

19. 19 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Thoracotomy  Open surgery of the thoracic cavity A, Incision made following the curve of the fifth rib. B, The muscles are divided. (Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)

20. 20 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Thoracotomy (cont.) (Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)

21. 21 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery (Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)  Thoracotomy (cont.)

22. 22 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lobectomy  Removal of a lobe of the lung to prevent the spread of metastatic cancer or to treat a benign tumor  May be performed as video-assisted procedure

23. 23 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lobectomy Placement of the proximal bronchus clamp 1.5 to 2 cm from main bronchial trunk. (Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)

24. 24 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Pneumonectomy  Procedure involves removal of entire lung  Procedure done to Debulk malignant tumor Slow spread of cancer Treat extensive abscess Treat bronchiectasis

25. 25 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Cervical rib resection for thoracic outlet syndrome  Thoracic outlet syndrome is compression of subclavian vessels and brachial plexus at superior aperture of thorax  Decompression includes partial or entire removal of rib

26. 26 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Decortication of the lung  Surgical removal of fibrin layer of the lung to facilitate lung expansion

27. 27 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Decortication of the lung  Surgical removal of a portion of the parietal pleura

28. 28 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lung transplantation  Performed to remove diseased, poorly functioning lung and replace with lung from organ donor

29. 29 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lung transplantation (cont.)  Indicated for patients with Restrictive lung disease Emphysema Pulmonary hypertension Other noninfectious end-stage pulmonary diseases

30. 30 Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. Thoracic Surgery  Lung transplantation (cont.)  In single-lung transplant, surgeon will make three anastomoses: Bronchus to bronchus Pulmonary artery to pulmonary artery Recipient pulmonary veins to donor atrial cuff  In bilateral transplant May require cardiopulmonary support