Thoracic Surgery

Question 1

What is the main reason for a pneumonectomy?

Answer 1

Almost always because of tumour high up in airways

Question 2

What position should be avoided for patients with a pneumonectomy?

Answer 2

Removed lung side up

- Fluid in the space, causing it to be heavy, compresses good lung in this position

Question 3

What incision is used for a pulmonary resections?

Answer 3

Posterolateral thoracotomy - also used in oesophageal & some cardiac surgery

Question 4

Where is a posterolateral thoractomy incision located?

Answer 4

From anterior axillary line approx 6th-7th IC space, running up past inferior angle of scapula to spinous process

Question 5

What muscles are cut in a posterolateral thoractomy?

Answer 5

• Trapezius
• Lats
• Serratus anterior

Question 6

What is an anterolateral incision used for?

Answer 6

• Trauma

- Patients who are CV unstable

Question 7

Where is an anterolateral incision located & what muscles are cut?

Answer 7

• Submammary from midline anteriorly to mid axillary line

- Pec major/minor, serratus anterior, intercostals

Question 8

What is a pleurodesis?

Answer 8

Pleural surfaces are irritated so they adhere together

Question 9

What condition is a pleurodesis used for?

Answer 9

Malignant pleural effusion - patient gets it constantly, pleural space stuck together to decrease occurrence

Question 10

What does pleurectomy and decortication involve?

Answer 10

Stripping away the pleura if fibrosed or in the presence of malignancy

Question 11

What is the less invasive procedure used for lung and pleural examination/surgery?

Answer 11

Video assisted thorascopy (VAT)

Question 12

What post-op outcomes is a PLT associated with?

Answer 12

• Impairment of VC & 6 minute walk test for up to 6 months
• Worse post op pain & reduction in lung function

Question 13

What did Reeve et al (2010) find in regards to PPCs post thoracotomy?

Answer 13

No difference in PPCs between patients receiving post op physio & patients who just mobilised with medical staff

Question 14

What did Reeve et al (2010) find in regards to shoulder pain post thoracotomy?

Answer 14

Lower total pain scores in treatment group at 1 & 3 months

Question 15

What role does physio have for thoracotomy patients?

Answer 15

• Non-standard patients who can’t mobilise may need treatment
• Musculoskeletal exercise prescription & advice to reduce shoulder pain & increase function