Lobectomy

What is lobectomy?

A lobectomy is a surgical procedure that is performed to remove a diseased lobe of the lung. Your lungs consist of five lobes.

The left lung has two lobes while the right one has three. If the lobe has malignant tumors, it needs to be surgically removed.

Other conditions that may necessitate a lobectomy include:

• Trauma

• Tuberculosis

• Severe chronic obstructive pulmonary disease (COPD)

A lobectomy involves making an incision on the front of your chest. This exposes your ribs, allowing the surgeon access to your chest cavity.

Sometimes, the surgeon may elect a less-invasive procedure such as video-assisted thoracoscopic surgery (VATS).

The surgeon makes several small cuts as opposed to a single large cut. A thoracoscope is inserted into your chest cavity.

The thoracoscope gives images of your internal organs on a small screen. The surgeon inserts the other small tools via the rest of the cuts to perform the procedure.

When is lobectomy surgery necessary?

In case one of your lobes has a problem, you might need a lobectomy. This is important for lung cancer or tuberculosis.

A lobectomy ensures that the disease does not spread to the other lobes. The procedure is also useful in treating various lung and chest conditions:

• Emphysema – Emphysema refers to chronic conditions that are characterized by loss of elasticity in your lungs

• Loss of elasticity means your lungs cannot move as you breathe

• Tuberculosis (TB) – A chronic illness caused when mycobacterium tuberculosis bacteria attack your lungs

• Bening tumor – A non-cancerous growth that affects how your lung functions. It puts pressure on blood vessels

• Fungal infection – This can cause damage to your lungs for which you need a lobectomy

• Lung damage that causes bleeding

• Lung defects present at birth

• Lung abscess – This refers to the formation of pus in your lungs. In case the abscess proves resistant to antibiotics, you might need to have it surgically removed

Types of lobectomy procedures

There are different methods of performing a lobectomy:

Open lobectomy

In this procedure, the surgeon makes a long incision on one side of your chest to spread the ribs apart. The surgery is also called a thoracotomy.

Spreading the ribs apart allows the surgeon to access your lung and remove the diseased lobe.

Open lobectomy is popular when you have stage 2 and stage 3 tumors in your lungs and they require removal.

Robotic surgery

The surgeon performs a robotic procedure using robotic arms that he/she controls from a console next to the patient.

The surgeon makes three to four cuts of about half an inch between two of your ribs. The procedure is fast and leads to limited bleeding and faster recovery. The risk of infection is also reduced.

Robot-assisted thoracoscopic surgery (RATS)

This procedure utilizes the da Vinci surgical system. The surgeon operates the robotic arms of the machine from a console next to the patient.

It helps to perform the procedure at high levels of precision. RATS is more expensive in comparison with either a VATS or an open lobectomy.

Video-assisted thoracic surgery (VATS)

This is a minimally invasive surgery mostly popular with early-stage lung cancer. The surgeon introduces a thoracoscope and other surgical tools and incisions between ribs.

Since the incisions in the VATS procedure are smaller it means faster recovery for the patient and reduced hospital stay. The procedure also comes with fewer complications and less chest drainage.

Benefits of a lobectomy

• An effective cure for lung cancer in its early stages

• There is less risk of loss of blood after a VATS procedure

• With a VATS procedure, the scarring and pain after surgery is less severe

• Less pain

Side effects of a lobectomy

A lobectomy surgery may be accompanied by the following risks and/or complications:

• Blood clots (especially in the leg region)

• Infection

• Bleeding that might necessitate blood transfusion or surgical opening of your chest

• Irregular heartbeat

• Nerve injury with impaired voice function

• Empyema – Empyema is a condition where a section of your chest cavity contains pus

• Pleural effusion – This happens when the space between your inner chest wall and lung gets filled with fluid

• Pneumothorax – The pneumothorax condition leads to a collapsed lung due to the presence of air in the pleural space

The risk differs from one person to another. For example, a patient with poor general health or a preexisting chronic condition could be more predisposed to post-surgical risk.

Preparing for a lobectomy

Persons with lung cancer may necessitate additional tests. This helps your provider to establish the extent to which the cancer cells have spread.

Such staging allows your provider to recommend the most effective treatment for your condition.

Your surgeon will also undertake a complete physical examination to determine the overall quality of your health. Some of the pre-surgical tests that your provider can order include:

• Positron emission tomography (PET) scan

• Blood tests

• Chest X-ray

• Cardiac stress test

• Magnetic resonance imaging (MRI)

• Pulmonary function test

In case of a preexisting heart condition, you need to have a cardiologist assess your health. Depending on the outcome of pre-surgical tests, your doctor might recommend pulmonary rehabilitation.

This is a program that is aimed at improving your breathing. Your doctor may also advise you to undertake physical therapy or additional pulmonary rehabilitation sessions post-surgery.

Your healthcare provider will organize a meeting with an anesthesiologist to explore pain management during a lobectomy while you are recovering.

Let your anesthesiologist know of any allergies or sensitivities. If you have a confirmed pregnancy or suspect to be the case, let your provider know of this.

If you are a smoker or use any tobacco products, your provider will likely advise you to stop using them for about a month before surgery. The goal is to minimize surgical complications.

Daily exercise, including breathing exercises, improves your lung functionality. You will be advised not to drink or eat anything past midnight before the procedure.

If you are taking any medication whether prescribed or over-the-counter, let your provider know of this.

Certain medications can interfere with surgery and if this is established, you will be advised to discontinue.

Make sure you have followed all the instructions on medication by your provider.

What happens during a lobectomy?  

A lobectomy is performed under general anesthesia. That means you will be unconscious during the surgery. It also means you will not feel the pain. 

An anesthetist inserts an intravenous (IV) line into your hand or arm. You are likely to receive antibiotics pre- and post-surgery. 

General anesthesia is administered. It ensures you remain asleep over the duration of surgery. The medication also prevents pain. 

You will breathe with the aid of a ventilator that is connected to a breathing tube that runs down your throat. 

A catheter is connected to your bladder to assist with the draining of urine. If the surgical area has hair around it, this will need to be trimmed. 

The surgical team also uses an antiseptic solution to clean the skin around the surgical area. The surgeon makes a chest incision that runs parallel to the diseased lobe. 

The incision extends under your arm right through your back. Once the surgeon has a clear view of your ribs, he/she will spread the ribs via a special tool. 

The surgeon proceeds to remove the lung lobe. The surgical team attaches several tubes to drain fluid and air from your chest. 

The surgeon uses staples or stitches to close the incisions. The area is sealed with dressing. 

A thin tube helps to inject pain medication into your lower spine. This can happen in the surgical room or in the intensive care unit (ICU) as you recover from surgery.

After the procedure  

You will be transferred to an ICU or a recovery room. As you regain consciousness, you will feel confused and sleepy. This is due to the effects of general anesthesia. 

Your healthcare team will closely watch you and monitor your heart rate and breathing.

Your surgeon may order a chest- X-ray to ascertain that your lungs are alright. In case you require pain medication, your healthcare team will administer the proper dosage. 

Most people spend several days in the recovery room barring any post-surgical complications. 

The healthcare team will insert one or more tubes in the area of the incision. These tubes help to avoid an accumulation of fluid or air from your chest. 

You are likely to experience pain due to chest tubes when breathing or moving. Your lungs require a re-expansion following surgery. This means that you will have to learn how to cough and breathe properly. 

These exercises help to avoid pneumonia. You require oxygen for some time following surgery. 

Some patients are required to use oxygen even after getting discharged from the healthcare facility. Others stop using it before being discharged. 

You will be encouraged to start moving around as soon as your health permits. This promotes faster healing of your lungs. 

You are advised to start taking fluids several hours post-surgery. You will slowly begin taking food as soon as you are in a position to do so. 

Your provider will organize a follow-up appointment before you get discharged from the hospital. Make sure there is someone on standby to drive you back home after discharge. 

Recovery

Your stay in the hospital after a lobectomy is determined mainly by the type of procedure that you underwent.

If you underwent a less invasive procedure such as RATS or VATS, you will likely spend about 3 days in hospital. This is because the procedure is less painful than the conventional thoracotomy.

Your healthcare provider will organize a follow-up appointment following a lobectomy. This can happen after seven to 21 days.

During this time, your provider discusses with you the outcome of surgery. Your surgeon will order a chest- X-ray to assess your wounds.

This is also the time when your provider advises you on diet and exercise as part of your recovery plan.

After leaving the hospital following a lobectomy, you will feel weak and tired. You need not worry as this is part of your recovery.

You are encouraged to move around the house even when you do not feel like it. Moving helps ensure your lungs remain functional and prevents blood clots.

Do not engage in strenuous physical activities such as lifting heavy objects or driving.

Wait for your doctor to give you the go-ahead to engage in such physical activities.

Following all the instructions by your healthcare provider on which medications to take and the frequency.

You will experience some discomfort in the first few months after a lobectomy. This can be taken care of using pain medication. Warm showers are also recommended as they ease sore muscles.

Some people develop constipation after surgery. This is caused by limited movement and pain pills.

You should experience a normal bowel movement once you are no longer taking pain medication.

Your doctor may also prescribe stool softeners and laxatives for your constipation.

Avoid the following during recovery:

• Individuals with flu and other respiratory infections

• Paint and other chemical fumes

• Tobacco smoke

• Environmental pollution

If you experience the following symptoms, call your doctor immediately:

• Shortness of breath

• Labored breath

• Confusion

• Fever above 38°C

• In case the incision site is leaking fluid or blood

• If the site of the incision is swollen or has a redness around it

• Blood-stained, green or yellow sputum

• Cough

The cost of a lobectomy in India

The cost of a lobectomy in India varies from one provider to another. Some of the factors include:

• Facility – That is whether the patient has opted for a private, trust, or public

• Diagnosis -The nature and number of diagnostic tests ordered by your provider

• Duration of stay in hospital

• Consultation fee

• Age of the patient

• City/Location

• Patient’s overall health

• Admission fee

The table below gives the average cost for lobectomy surgery in various Indian cities:

References

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