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Transcript of 1 Chapter 32 Thoracic and Pulmonary Surgery. 2 Elsevier items and derived items © 2010, 2007 by...
1
Chapter 32Chapter 32
Thoracic and Pulmonary Thoracic and Pulmonary SurgerySurgery
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 2
Thoracic Surgery
Review terms and definitions listed at beginning of chapter
Use your medical dictionary if necessary
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 3
Thoracic Surgery
Lung function Ventilation Diffusion Perfusion
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 4
Thoracic Surgery
Bronchi Left and right primary Branch off at the carina Become bronchioles Terminate at the alveoli
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 5
Thoracic Surgery
Lungs and bronchial tree.(From Herlihy B, Maebius NK: The human body in health and illness, ed 2 Philadelphia, 2003, Saunders.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 6
Thoracic Surgery
Lungs Paired organs separated by the mediastinum Enclosed in the pleural cavity Covered by the pleural sac Expand based on negative pressure created by
the space between the two layers
Lung pressure Break in integrity of pleural cavity causes a
collapse
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 7
Thoracic Surgery
Mechanism of breathing.
(From Herlihy B, Maebius NK: The human body in health and illness, ed 2, Philadelphia, 2003, Saunders.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 8
Thoracic Surgery
Diagnostic testing Pulmonary function Laboratory test Imaging studies
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 9
Thoracic Surgery
Instruments General surgery instruments Chest wall instruments Lung instruments Bronchus clamps Surgical stapling devices Vascular clamps
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 10
Thoracic Surgery
A. Thoracotomy instruments. Top, left to right: 1 malleable T retractor, 1 Giertz rib rongeur, 1 Matson rib stripper, and elevator. Bottom left: Burford rib spreader with shallow blade attached; 1 shallow blade; 2 deep blades.(From Tighe SM: Instrumentation for the operating room, ed 6, St Louis, 2003, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 11
Thoracic Surgery
Chest Drainage System
(From Lewis SM, Heitkemper MM, Dirksen SR: Medical surgical nursing, ed 6, St Louis, 2004, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 12
Thoracic Surgery
Video-Assisted Thoracoscopic Surgery
A, Trocar placement. B, Isolation of lung tissue. C, Insertion of endoscopic stapler. D, Resection of wedge.(Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 13
Thoracic Surgery
Video-assisted thoracoscopic surgery Patient position
• Lateral with an axillary roll
Anesthetic • General
Trocar placement • Dependent upon procedure
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 14
Thoracic Surgery
Thoracoscopy – Lung biopsy Removal of a small portion of lung tissue for
pathological examination Performed when other diagnostic tests are
inconclusive Completed as a video-assisted procedure
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 15
Thoracic Surgery
Lung volume reduction Patients with chronic pulmonary emphysema may
benefit• Involves resection of portions of a lung in which air is
trapped in emphysematous lung tissue
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 16
Thoracic Surgery
Bronchoscopy
A, Top to bottom: Insertion of rigid bronchoscope. Endobronchial obstruction. Flexible scope is placed inside rigid scope for biopsy. B, Removal of mass using forceps. Laser removal.(From Sugabaker DJ, Strauss G, Fried MP: Laser resection of endobronchial lesions: Use of rigid and flexible bronchoscopes, Oper Tech Otolaryngol Head Neck Surg 3:93, 1992.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 17
Thoracic Surgery
Mediastinoscopy Endoscopic examination of the mediastinum through
incision Thymus and lymph node biopsy are performed to
establish a diagnosis
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 18
Thoracic Surgery
Thoracotomy Open surgery of the thoracic cavity
• Thoraco = Chest cavity
• Otomy = Incision into
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 19
Thoracic Surgery
Thoracotomy Open surgery of the thoracic cavity
A, Incision made following the curve of the fifth rib. B, The muscles are divided.(Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 20
Thoracic Surgery
Thoracotomy (cont.)
(Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 21
Thoracic Surgery
(Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)
Thoracotomy (cont.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 22
Thoracic Surgery
Lobectomy Removal of a lobe of the lung to prevent the
spread of metastatic cancer or to treat a benign tumor
May be performed as video-assisted procedure
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 23
Thoracic Surgery
Lobectomy
Placement of the proximal bronchus clamp 1.5 to 2 cm from main bronchial trunk.(Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.)
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 24
Thoracic Surgery
Pneumonectomy Procedure involves removal of entire lung Procedure done to
• Debulk malignant tumor
• Slow spread of cancer
• Treat extensive abscess
• Treat bronchiectasis
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 25
Thoracic Surgery
Cervical rib resection for thoracic outlet syndrome Thoracic outlet syndrome is compression of
subclavian vessels and brachial plexus at superior aperture of thorax
Decompression includes partial or entire removal of rib
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 26
Thoracic Surgery
Decortication of the lung Surgical removal of fibrin layer of the lung to
facilitate lung expansion
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 27
Thoracic Surgery
Decortication of the lung Surgical removal of a portion of the parietal pleura
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 28
Thoracic Surgery
Lung transplantation Performed to remove diseased, poorly
functioning lung and replace with lung from organ donor
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 29
Thoracic Surgery
Lung transplantation (cont.) Indicated for patients with
• Restrictive lung disease
• Emphysema
• Pulmonary hypertension
• Other noninfectious end-stage pulmonary diseases
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc. 30
Thoracic Surgery
Lung transplantation (cont.) In single-lung transplant, surgeon will make three
anastomoses:• Bronchus to bronchus
• Pulmonary artery to pulmonary artery
• Recipient pulmonary veins to donor atrial cuff
In bilateral transplant• May require cardiopulmonary support