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Surgery of Abdomen and Thorax Cavitities > Lung Lobectomy and Pericardiectomy > Flashcards

Lung Lobectomy and Pericardiectomy Flashcards

1
Q

Name conditions where a lung lobectomy is indicated (10)

A
  • Cyst
  • Bullae
  • Blebs
  • Broncho-oesophageal fistula
  • Consolidated lung lobe
  • Abscess
  • Bronchiectasis
  • Lung laceration
  • Lung lobe torsion
  • Pulmary neoplasia
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2
Q

What are the 2 techniques for lung lobectomy?

A

Hand or stapler

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3
Q

What must be done following a lung lobectomy to assess for leakage of air?

A

Flooding the thoracic cavity with saline

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4
Q

What must be done following lung lobectomy if neoplasia is suspected? (2)

A

Wound edges must be protected from seeding
Kit/gloves changed

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5
Q

What total lung volume can be lost in dogs?

A

50%

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6
Q

What % of lung loss is fatal?

A

75%

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7
Q

What occurs after >60% of pulmonary arterial outflow?

A

Acute pulomonary hypertension

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8
Q

Why is it possible to excise the whole of the left lung? (If right is healthy)

A

Left lung - 42% of lung tissue (and left lung 58% )

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9
Q

What are the advantages of using stapler for lung lobectomy? (2)

A
  • Reduced surgical time
  • Minimal leakage
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10
Q

What is the disadvantage of staplers for lung lobectomy? (1)

A

Cost

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11
Q

List possible complications of a lung lobectomy.

A
  • Pulmonary Oedema
  • Haemorrhage
  • Bonchopleural fistula
  • Lung lobe torsion
  • Portal site metastasis
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12
Q

When is a bronchopleural fistula seen after lung lobectomy? How is it resolved?

A

Up to 3 weeks postop
Emergent surgical re-exploration

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13
Q

How do we prevent the post op failure to achieve an air tight suture line?

A

The site should be checked for air leakage with saline and patients monitored closely post-operatively.

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14
Q

How to prevent haemorrhage following lung lobectomy? (3)

A
  • Double transfix all vessels
  • Individually suture large vessels before stapling
  • En bloc stapling of the hilus should be performed with a vascular stapler
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15
Q

How to prevent airway obstruction in lung lobectomy?

A

Ensure lung manipulation is minimised until complete cross-clamping of the bronchus is achieved distal to the proposed resection site.

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16
Q

What should be monitored if there is intra-op pleural contamination? (2)

A
  • Pyrexia
  • Pleural effusion
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17
Q

What can be done regarding post operative subcut emphysema?

A
  • Should resolve spontaneous if local
  • If generalised can disrupt vascular supply to skin
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18
Q

What is the most common post operative cardiac complication following lung lobectomy? how common is this?

A

Supraventricular tachycardia 25-75%

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19
Q

Following a lung lobectomy, what causes Acute Respiratory Distress Syndrome? (2)

A
  • Inflammation
  • Increased vascular permeability
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20
Q

What are suggested causes of pulmonary oedema? (3)

A

Perioperative fluid overload
Impaired lymphatic drainage
Surgical trauma

BUT pathogenesis is unknown.

21
Q

When is risk of a respiratory insufficiency greatest following lung lobectomy?

A

right pneumonectomy is performed.

22
Q

What can a mediastinal shift cause, and how is this then managed?

A

Result in regurgitation; which can be medically managed

23
Q

When has an acute anaphylactic shock been reported with a lung lobectomy?

A

In a patient with heartworm

24
Q

Define partial lung lobectomy

A

Removal of the distal two thirds or less

25
Q

What approaches can a partial lung lobectomy be performed via? (3)

A

Intercostal thoracotomy
Median sternotomy
Thoracoscopic approach.

26
Q

What stapler type is preferred for a partial lung lobectomy?

A

Linear stapler (e.g., Proximate TX) with a staple leg length of 2.5 mm

27
Q

Where is a stapler positioned compared to lesion to deploy?

A

Proximal to

28
Q

Where the lobe transected compared to the stapler?

A

Distal to

29
Q

What stapler type can be used in smaller patients?

A

linear cutting stapler is useful: it deploys two or three staggered rows of staples either side of a cutting blade

30
Q

How is a parital lung lobectomy performed by hand? Discuss suture

A

The site to be removed is identified and crushing forceps placed at the level of the proposed resection, allowing adequate gross margins, depending on the diagnosis.
Two rows of continuous overlapping suture are placed 2 mm proximal to the forceps using an absorbable monofilament suture.
If large bronchi or blood vessels are identified, they are ligated individually.
The lung is transected proximal to the forceps, the edge of the lung is oversewn and observed for leakage.

31
Q

How are leaks identified by flooding thorax with saline? How is this rectified?

A

Air bubbles
rectify with interrupted absorbable monofilament sutures.

32
Q

What approach is used for a total lung lobectomy?

A

Lateral intercostal approach

33
Q

What must be transected during a caudal lung lobectomy to mobilise the lung? Where does this run

A

Pulmonary ligament - runs from the caudal edge of the hilus to the mediastinal pleura.

34
Q

Which is the stapler of choice for a total lung lobectomy?

A

vascular stapler (usually 3.5 mm), which will deploy three staggered rows of staples and will occlude the vessels and bronchus when placed across the hilus

35
Q

How to avoid contamination from total lung lobectomy following stapling?

A

Non-crushing clamps are positioned distal to the stapler and the lung transected proximal to the clamp,

36
Q

How is the bronchus removed?

A

The bronchus is clamped with two Satinsky forceps and a horizontal mattress suture placed proximal to the clamps and tied.
The bronchus is transected between the clamps and the end oversewn with a simple continuous pattern.
The site is leak tested.

37
Q

How much lung should be left on distal aspect when incising portion to be removed?

A

5mm

38
Q

What pressure should lungs be inflated to when doing a leak test?

A

20cm water

39
Q

When is a pneumonectomy required?

A

Disease processes affecting one lung where the contralateral lung is normal

40
Q

What approach is made for a pneumonectomy?

A

intercostal thoracotomy

41
Q

When is pericardiectomy indicated? (2)

A
  • Pericardial effusion causing tamponade
  • Chylothorax
42
Q

What must we do with pericardial effusion samples? (2)

A
  • Histopathology
  • Bacteriological analysis
43
Q

What approach is made for a pericardectomy? (2)

A

Median sternotomy
Right interspace thoracotomy

44
Q

Which approach for pericardiectomy has been described but has limited visualisation and therefore should be avoided?

A

Transdiaphragmatic subxiphoid open approach

45
Q

How is the pericardium removed, position and transection in a paritial pericardiectomy?

A

Parallel and Ventral to both phrenic nerves
- sternopericardial ligament is transected and the pericardium removed.

46
Q

After removing pericardium ventral to phrenic nerve, how is this converted into a total?

A

Remove pericardium dorsal to phrenic nerves

47
Q

Where are ports positioned for a thoracoscopic pericardiectomy?

A

a subxiphoid camera port is placed, along with two instrument portals (positioned in the right and left 7th intercostal space, or the right 4th and 7th intercostal space)

48
Q

What are potential complications of a pericardectomy? (5)

A

Haemorrhage
Cardiac tamponade
Phrenic nerve injury
Cardiac herniation
Recurrence of pericardial effusion.

Surgery of Abdomen and Thorax Cavitities (10 decks)

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