69 - Pulmonary lobectomy

Summary

Pulmonary lobectomy is most often performed for benign and malignant neoplasms of the lung. It may also be required for pulmonary tuberculosis, refractory lung abscess, residual bronchiectasis, pulmonary sequestration, and other infectious processes.

General anesthesia is administered through an indwelling double-lumen endotracheal tube. In general, the operation does not require blood transfusion, although blood should always be available in case technical problems arise. Patients are usually placed in the lateral decubitus position with the operated side superior. The main operative steps after thoracotomy incision consist of control of the arterial supply and venous drainage of the respective lobe, followed by dissection of the fissures and division of the bronchus. The operation takes 1½ to 2 hours for a lower lobectomy and 2 to 2½ hours for an upper lobectomy. The procedure is generally well tolerated and is not a major surgical stress if patients have few associated medical problems and adequate pulmonary function.

Usual postoperative course

Expected postoperative hospital stay

Depending on their general condition and the degree of postoperative air leak, patients remain in the hospital for 5 to 7 days.

Operative mortality

1%–3% for elective surgery and 15%–25% for emergency intervention.

Special monitoring required

Intensive care unit observation is required for 1 day for careful monitoring of vital signs, chest tube drainage, arterial blood pressure, urinary output, renal function, and ventilatory status.