LOBECTOMY

.C SALATI Msc physio

• A lobectomy is a surgery to remove one of the
lobes of the lungs. The lungs have sections
called lobes. The right lung has 3 lobes. The
left lung has 2 lobes. A lobectomy may be
done when a problem is found in just part of a
lung. The affected lobe is removed, and the
remaining healthy lung tissue can work as
normal.
• A lobectomy is most often done during a
surgery called a thoracotomy. During this type
of surgery, the chest is opened.
• The cut is most often made on the front of the
chest under the nipple and wraps around the
back under the shoulder blade. The surgeon
gets access to the chest cavity through the
exposed ribs to remove the lobe.
• In some cases, a video-assisted thoracoscopic
surgery (VATS) is used to do a lobectomy. This
is a less-invasive procedure. With this type of
surgery, 3 or 4 small cuts are used instead of 1
large cut. Tiny tools are put into the chest
cavity.
• One of the tools is called a thoracoscope. It’s a
tube with a light and a tiny camera that sends
images to a computer screen. This shows the
internal organs on the screen. The small tools
are used through the other cuts to do the
surgery.
• Chest and lung health conditions that may be
treated with lobectomy include:
• Tuberculosis (TB). 
• Lung abscess. 
• Emphysema. 
• Benign tumor. 
• Lung cancer. 
• Fungal infection.
 Risks of a lobectomy

• Infection
• Pneumothorax
• Bleeding
• A bronchopleural fistula
• Empyema)
• Fluid in the space between the lung and inner
chest wall (pleural effusion)
• Your risks may vary depending on your general
health and other factors. 
• One or more chest tubes near incision to
drain air or fluid from the chest. The chest
tubes may cause pain when you move, cough,
or breathe deeply.
 PNEUMONECTOMY
• The entire lung is removed. In a radical
pneumonectomy, mediastinal lymph nodes
and part of the chest wall may also be
removed. The resulting cavity will be filled
with protein rich fluid and fibrin. Unlike the
situation with most other forms of thoracic
surgery, a chest tube is not inserted following
pneumonectomy, and the air is therefore not
evacuated.
• The cavity size is reduced by lateral shift of the
trachea and heart , upward shift of the
diaphragm, and reduction of the intercostals
paces on the operated side.
 RISK FACTORS
• Right-sided pneumonectomy is associated
with a higher mortality rate than left-sided
pneumonectomy . While the reasons are not
certain, likely factors include several life-
threatening complications that are
encountered more frequently after right
pneumonectomy; these include
postpneumonectomy space empyema,
bronchopleural fistula, and
postpneumonectomy pulmonary edema.
• Pneumonectomy performed emergently for
trauma or massive hemoptysis is associated
with a mortality rate exceeding 35 percent,
likely reflecting the severity of the underlying
process
• Several comorbid medical illnesses have been
identified as risk factors for increased
mortality. These include underlying lung
disease, coronary artery disease, heart failure,
atrial fibrillation, hypertension, hemiplegia,
active cigarette smoking, and weight loss
greater than 10 percent within the six months
preceding surgery
 COMPLICATIONS
• PULMONARY COMPLICATIONS — Potential
pulmonary complications following
pneumonectomy include postpneumonectomy
pulmonary edema, postpneumonectomy
syndrome, and intraoperative spillage of material
into the remaining lung.
• Pulmonary edema — Postpneumonectomy
pulmonary edema occurs with an overall
frequency 
 PLEURECTOMY
• The parietal pleura over the lateral wall is
removed leaving a raw surface to which the
visceral pleura and lung will adhere. At the
same time the area on the visceral pleura
which is leaking air is oversewn.
 INDICATIONS
• Mesothelioma: Mesothelioma is cancer-
related to asbestos exposure
•  persistent or recurrent pleural effusions 
• Recurrent pneumothorax
 Risks of pleurectomy include:

• Anesthesia-related headache, nausea, and drowsiness

• Bleeding
• Infection
• Damage to the lungs and other organs in the chest cavity
• Persistent air leak (sometimes it can be difficult to remove
a chest tube following a pleurectomy due to a persistent air
leak)
• Recurrence of pleural effusion or pneumothorax due to
include inadequate removal of pleural tissue
• Scar tissue (adhesions) may develop in the chest
and chronic pain may occur in some people
 CARDIOPULMONARY BYPASS
• Most procedures are carried out with the aid
of the above bypass ,the circulation through
he heart is interrupted so that the surgeon
can see the internal defect. It is a technique by
which the pumping action of the heart and gas
exchange functions of the lungs are
temporarily replaced by a mechanical device.
 PHYSIOTHERAPY TREATMENT
• 1.Deep breathing excises(unilateral costal on
the good side and diaphramatic )
• a.Unilateral shakings on the good side during
expiration
• b. Huffing with good support of the incision.
• 2. Full range active /assisted shoulder
exercises
• 3. Active, foot and ankle exercises
• 4.a.Bilateral costal an diaphramatic breathing
exercises
• B. trunk and shoulder girdle exercises and
postural correction.
• Early mobilisation to improve excise tolerance