Pulmonary Surgical Management

4 categories of thoracic surgical procedures

biopsy, removal of portions/all of lung, lung volume reduction, and lung transplant

Surgical approach used when full visualization of the chest wall is not needed; less invasive procedure

video-assisted thoracoscopic surgery (VATS)

Most commonly used thoracic procedure in which the lower trap, serratus, and lats are split and ribs spread; significant post-op pain; potential shoulder dysfunction due to separation of muscles

posterolateral thoracotomy

Surgical approach in which exposure of the heart is needed - sternum is split open.

Median sternotomy

Surgical approach in which both sides of thorax needs to be viewed; used in lung transplants.

Bilateral anterolateral thoracotomy (clamshell incision)

Surgery in which they remove hyperinflated segments of the lung; staple & seal remaining tissue

Lung volume reduction surgery

What is the most common type of lung volume reduction surgery?

upper lobectomy

Procedure in which a one-way valve is inserted into segmental or sub-segmental bronchi or hyper-inflated portions of lung; air blocked during inhalation but allowed to exit during exhalation.

endobronchial valve implantation

Large air-filled space that impairs gas exchange.

Bullae

(Single or Double) lung transplant is more effective.

Double

(Single or Double) lung transplant is more common.

Single

Indications for lung transplant (5)

COPD (emphysema), pulmonary fibrosis, cystic fibrosis, idiopathic pulmonary arterial hypertension, sarcoidosis

Contraindications for lung transplant (3)

active malignancy, poor compliance, unwillingness to change lifestyle

Where are chest tubes placed?

through the intercostal space into the pleural space

Post-op PT management includes what 5 general categories?

facilitate elimination of secretions, improve breathing patterns, increase activity tolerance, activity pacing, relaxation