Lung Lobectomy

WHAT YOU SHOULD KNOW:

• Lung lobectomy is a type of thoracotomy surgery done to remove one or more lobes of your lung. Your lungs are two hollow organs that are covered by pleural sacs (two thin layers of tissue). Each lung is divided into lobes (sections) by deep grooves. Normally, your right lung has three lobes while your left lung has two lobes. Lung lobectomy is usually done to treat lung tumors, infections including abscesses (pus), or lung damage. With lobectomy, your caregiver will cut and remove only one lobe of your lung. If two lobes of the right lung are removed, the surgery is called bilobectomy. Your caregiver leaves one or two lobes of the lung in place to allow for normal lung function.
  
  
• During lobectomy, your caregiver may rejoin the airways he had cut and reattach them to the remaining lobes. This is called sleeve lobectomy. This is often done if a tumor is in the center part of your lungs. Your caregiver may also reattach the cut arteries along with the cut airways. This is called a double sleeve technique. Other parts in the area may also be removed, aside from the lung lobe. These include lymph nodes (glands) between the lobes, chest muscles, tissue lining of your heart, or diaphragm. You and your caregiver will decide which lobectomy technique is best for you.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During your lung lobectomy, you may bleed more than usual. You may have trouble breathing or get pneumonia afterwards. Other organs or tissues near your lung may be damaged or you may get an infection. You may have pain, which may make it hard for you to breathe well. Air and fluid may leak from the lung that was opened. When this happens, your chest tube may need to stay in place for a longer time. You may also need to stay in the hospital longer. People who smoke or have a heart disease are at higher risk for having problems.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without this surgery you may have other problems. You will need more tests to find the cause of your condition, which may take longer than having lobectomy. It may also be harder to find the exact cause of your condition. You may have lung cancer and not know it as soon. The cancer cells may spread or your condition may become worse, and you may die. Call your caregiver if you are worried or have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine to make you feel relaxed and sleepy right before your surgery. You are taken on a stretcher to the room where your surgery will be done. You will then be moved to an operating table or bed.
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Special lines and tubes: Special IV lines are usually inserted after you are asleep. Small tubes may be put into an artery or vein before, during, or after surgery. These will help caregivers watch how you are doing during or after surgery.
    
    
    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
      
      
    • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.
      
      
    • Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
    
    
  • Tests:
    
    
    • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
      
      
    • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
      
      
    • Computed tomography scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your chest. You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.

During your surgery:

• You are placed lying on your side. Your skin is cleaned with soap and water, and covered with sheets. A long incision is made between your two ribs, running from your back to your front. The cut is made to open one side of your chest and reach the lung. Your ribs may be cut away or pulled apart to help caregivers see your lung better. Once your lung is seen, a clamp is placed on your lung's blood vessels and airway tubes. This stops the blood and air from flowing through the area where the surgery will be done.
  
  
• The lobe of your lung is removed and the airways are then tightly sewn together. Your caregiver may reattach the sewn airways, or airways and arteries to your remaining lobes. One or more chest tubes may be put inside your chest to drain blood and fluid. Your incision is closed using a strong wire, stitches (thread), or staples. Your lung lobe may be sent to the lab for tests.

After your surgery:

You will be taken to the recovery room or your hospital room which may be in intensive care. A bandage is used to cover your stitches or staples to keep the area clean and prevent infection. Your caregiver will check you often, and you may be on monitors that your caregivers watch outside your room. Do not try to get out of bed until your caregiver says it is OK. You may need to stay in the hospital for 5 to 7 days after your surgery.

• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Blood thinners: You may be given medicine to thin your blood to keep you from getting blood clots.
    
    
  • Heart medicine: You may be given medicine to keep your heart from having abnormal beats.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Patient controlled analgesia: You may get pain medicine through an IV or an epidural line attached to a patient controlled analgesia (PCA) pump. Caregivers set the pump to let you give yourself small amounts of pain medicine when you push a button. Your pump may also give you a constant amount of medicine, in addition to the medicine that you give yourself. Let caregivers know if your pain is still bad even with the pain medicine.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Respiratory care:
  
  
  • Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.
    
    
  • Deep breathing and coughing: This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
    
    
    • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
      
      
    • You may be given an incentive spirometer to help you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Let out your breath and cough. Repeat the steps 10 times every hour.
    
    
  • Pleurodesis: This is done to treat air or fluid buildup in the chest that does not go away. It causes the two pleural layers to stick together. The pleura are thin layers of tissue that form a two-layered lining around the lungs. In between the two pleura is the pleural space (small, fluid-filled space). During a pleurodesis, a medicine or chemical is put into the pleural space through a chest tube. Talcum, silver nitrate, tetracycline, or blood patch (small amount of your blood taken from a vein) may be used. The medicine or chemical causes the pleural layers to become irritated and stick together, removing the space altogether.
    
    
  • Oxygen and a ventilator: You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).
  
  
• Tests and monitoring:
  
  
  • Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
    
    
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.