Lung Biopsy
Indications: Biopsy is performed as a
diagnostic procedure, usually retrieving a small piece of the lung for further
study. This is normally done in radiology and is normally done with small
needles that are directed to the appropriate spot by CAT scan technology. If
this method proves unsatisfactory, and in the cases of some very rare lung
diseases, a surgical biopsy is performed
Procedure: Surgical lung biopsy
is performed through a small 4 to 5 inch long incision on the chest wall. A
small piece of lung is removed. This piece is larger than the amount of tissue
obtained with a needle biopsy and preserves the natural architecture of the
tissues when the tissues are examined under a microscope. This is important in
the diagnosis of some of the rarer lung diseases. A "chest tube" which
is a small hose, is placed through the chest wall and into the chest cavity
after the biopsy. This tube removes any excess fluid, blood, or trapped air from
the chest cavity after the procedure. The tube thereby allows the lung to
re-expand fully afterwards.
courtesy of Ethicon - a Johnson and Johnson Company
Length of Stay: Length of stay depends
on the reason for the biopsy. Some patients with the rare infections or diseases
may be in the hospital for a lengthy period, but the biopsy itself requires only
three to four days in the hospital.
Recovery: Recovery is generally felt
to take four to six weeks for full recovery.
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Lobectomy
Indications: Lobectomy is the removal
of approximately one third of the right or left lung. Each lung is divided into
three large segments, called lobes. If one of these segments is damaged by
cancer, infection or trauma, it can often be removed, leaving the other segments
intact. This minimization of the tissue removed leaves more lung tissue intact
and thereby lessens the impact on the patient.
Procedure: A larger incision is
utilized in lobectomy, than in lung biopsy. The tissue between two ribs is
opened. The ribs are spread with a mechanical device that keeps the incision
open allowing the surgeon to work. The artery, vein and airway into the lobe are
tied off and cut, and the lobe removed. As with the biopsy, a chest tube is
placed to drain off any blood, fluid or air that may get trapped in the chest
cavity. The chest tube is slipped out on the second to the fourth day after
surgery ( as a general rule.)
Length of Stay: The average length of
stay in the hospital after lobectomy is five to seven days.
Recovery: Recovery after lobectomy is
six to ten weeks on the average. Manual laborers may not go back to work for up
to twelve weeks after the procedure to give time for the chest wall muscles to
heal properly.
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Pneumonectomy
Indications: Indications for
pneumonectomy are the same as those for lobectomy. Usually the disease process
is more advanced or severe however, as pneumonectomy means removal of one whole
lung.
Procedure: The procedure is the same
as lobectomy except that the main artery, vein and airway to an entire lung are
tied off and cut and the entire lung is removed. This is a much more significant
procedure than lobectomy, and patients therefore tend to stay in intensive care
for several days before moving to a surgical recovery floor of the hospital.
Length of Stay: Average stay in the
hospital is seven to ten days.
Recovery: Same as Lobectomy.
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Video
Assisted Thoracoscopy (V.A.T.S.)
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Mediastinoscopy
Indications: Mediastinoscopy is
essentially a procedure of historical interest. It is now rarely used to biopsy
lymph nodes in the mediastinum. The mediastinum is the space in the chest cavity
that is just under the breast bone, above the heart, and in front of the lungs.
On rare occasions, enlarged lymph nodes are seen in this area on a chest
x-ray. If there is an associated lung cancer, biopsy of the lymph nodes is
performed to see if lung cancer surgery should be performed. This biopsy is
often done using a needle guided to the right spot by CT scan. When this is not
possible, mediastinoscopy is sometimes performed.
Procedure: The procedure is done in
the operating room under general anesthetic. A small incision is made on the
neck, just above the breast bone. A scope is advanced into the mediastinal space
and any lymph nodes in the area are sampled.
Length of Stay: The procedure is
usually done as an outpatient.
Recovery: Recovery is only a day or
two. No restrictions in activity are expected.
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