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Glossary of thoracic operations

Theatre teamHere is a brief description of some chest operations.  Your team will advise you on the specifics of your own surgery.

'VATS' refers to video-assisted thoracic surgery, sometimes called 'keyhole' surgery.  This uses cameras and special equipment to avoid making large cuts in the chest wall or spreading of the ribs. A 'thoracotomy' is the standard open approach to the chest.. 

Lung resections

  • Lobectomy

The lung is divided into lobes (two on the left, three on the right). A lobectomy involves removal of an entire lobe. This has traditionally been achieved via a thoracotomy but is now often performed by VATS (keyhole) techniques  Usually, lymph glands from the hilum (root) of the lung and middle of the chest will also be removed at the same time.  This is the standard operation for lung cancer provided that the whole tumour can be removed. 

  • Pneumonectomy

This is the removal of an entire lung. The risk of the operation and the chances of breathlessness after surgery are higher than for lobectomy, although both are very dependant upon your own state of health before surgery.  For this reason, it is usually reserved for tumours where a lobectomy will not remove the entire cancer.

  • Segmentectomy

Each lobe of lung is divided into segments. Segmentectomy involves the removal of one segment. It is 'lung-preserving' surgery and can be performed for lung cancer in patients who are not fit for a complete lobectomy.

  • Wedge resection

This is the removal of part of the lung, usually using a stapling device. It is often performed to diagnose lung masses seen on a CT scan, to remove tumours which have spread from elsewhere in the body (known as metastases), or sometimes to treat lung cancer in patients who are not thought fit enough to undergo a lobectomy operation.  Although often performed with the VATS technique, but it can sometimes require a thoracotomy (open) incision.  

Other lung operationsMaria with patient

  • Lung volume reduction surgery

A very select group of patients with severe emphysema may benefit from this surgery. The aim is to remove redundant lung tissue. This allows the lung tissue that remains to re-expand. The mechanics of breathing may be improved. Thorough investigation and treatment, usually including smoking cessation, medical treatment and physiotherapy will take place before any surgery. 

Diagnostic procedures and bronchoscopy

  • Bronchoscopy 

The surgical bronchoscope is different from the flexible fibre-optic scopes used by physicians. It is a long rigid tube that is passed into the trachea (windpipe) under general anaesthetic. It enables visualisation of the airway and allows procedures such as biopsy and stent placement (to hold open a diseased airway) to be performed. Bronchoscopy is often performed as a day case.

  • Mediastinoscopy

Enlarged lymph nodes in the chest can be biopsied using an instrument called a mediastinoscope. A small incision is made over the trachea (windpipe) in the neck and the scope passed into the chest.  Results will usually take several days. Mediastinoscopy is often performed as a day case.

  • Anterior mediastinotomy

A small incision made over the second rib (usually the left) in order to biopsy lymph nodes or tissue in the mediastinum (middle of the chest) or at the hilum (root) of the lung.

  • Lung biopsy

In patients with suspected interstitial lung disease (an inflammatory or scarring disease of the lung tissue) a lung biopsy can help plan medical treatment. Biopsies are taken under general anaesthetic, usually using a VATS approach.

  • Pleural biopsy

Biopsy (sampling) of the pleura is performed to investigate collections of fluid in the pleural space (pleural effusion), or thickening of the pleura.  It is often combined with pleurodesis- the use of irritant material to create pleural adhesions- to prevent fluid collecting around the lung again after surgery.  This surgery is often performed using VATS techniques.

Operations for pneumothorax or collapsed lungStickers

Pneumothorax is the collapse of a lung, usually caused by air leaking from it.  This can happen spontaneously, particularly in young people.  It may also happen because of underlying lung disease, for example emphysema. Smoking increases the risk of many of these diseases.

There are several ways to treat pneumothorax, with different advantages and disadvantages.  When surgery is advised, it often includes removal of weakened areas of the lung (called bullae or blebs) if present, together with a procedure to "stick" the lung to the chest wall.  This can be achieved by stripping the pleura to create a raw surface, known as pleurectomy, or by using an irritant substance to induce inflammation, called pleuredesis.  Talcum powder specially prepared for the purpose has been used for many years.

In Bristol most of this surgery is now undertaken using VATS techniques.  Your own team will be able to discuss the options with you.

Developing a pneumothorax may affect flying and scuba diving in the future.  If this affects you, please discuss it with your team.

Surgery for chest wall deformity

Pectus carinatum (excessive prominence of the breastbone, or 'pigeon chest') and pectus excavatum (excessive indrawing of the breastbone, or 'funnel chest') can be treated by surgery in appropriate cases.  Currently the department undertakes between 20 and 30 operations for chest wall deformity every year.

Surgery for myasthenia gravis

Patients with myasthenia gravis (a disease characterised by progressive muscle weakness on repetitive use) often benefit symptomatically from removal of the thymus gland. Surgery is more successful if the patient is young with an early diagnosis.

In Bristol we perform a radical thymectomy via a neck incision (trans-cervical approach) with VATS techniques. This enables a quick recovery and often just an overnight stay in hospital.

If you have myasthenia gravis you will need to discuss with your neurologist whether a thymectomy is appropriate for you.