Our Summary

This research paper discusses the development of thoracic surgery, which is surgery related to the chest, towards less invasive techniques. These include not only the surgical approach, but also less aggressive anesthesia protocols and lung-saving resections (removal of parts of the organ). Despite the challenges, nonintubated anatomic segmentectomies (a surgery where a portion of the lung is removed without the use of a breathing tube) can be performed safely if certain key aspects are considered. These include carefully selecting patients, having previous experience in minor procedures, working with a multidisciplinary team, and following the four cornerstones: deep sedation (putting the patient into a deep sleep), regional analgesia (pain relief in a specific area), oxygen support, and vagal blockade (blocking certain nerve impulses). The paper points out that there have been better outcomes in recovery after surgery, including quicker return to eating, shorter time with a chest tube, and shorter hospital stay. The rates of complications and the need to switch to more invasive procedures are low. However, the paper suggests that these findings need to be confirmed in larger, multicenter clinical trials.

FAQs

  1. What is nonintubated thoracic surgery and how has it evolved?
  2. What are the key factors to consider when performing nonintubated anatomic segmentectomies?
  3. What are the potential benefits of nonintubated thoracic surgery and how should these be evaluated?

Doctor’s Tip

One important tip a doctor might give a patient undergoing lung surgery is to follow the post-operative care instructions closely. This may include taking medications as prescribed, avoiding smoking and secondhand smoke, practicing deep breathing exercises, and avoiding heavy lifting or strenuous activities. Adhering to these guidelines can help promote a successful recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended for lung surgery include those with:

  • Lung cancer or other tumors in the lungs
  • Severe chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Lung infections or abscesses
  • Lung nodules that may be cancerous
  • Bronchiectasis
  • Pulmonary fibrosis
  • Lung cysts
  • Pulmonary hypertension

It is important for patients to undergo a thorough evaluation by a multidisciplinary team of specialists, including thoracic surgeons, pulmonologists, radiologists, and oncologists, to determine the best course of treatment. The decision to undergo lung surgery should take into consideration the patient’s overall health, age, lung function, and stage of disease. Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery, may be recommended for eligible patients to reduce postoperative pain, complications, and recovery time.

Timeline

Before lung surgery:

  • Patient undergoes preoperative evaluations, including imaging studies and blood tests
  • Patient may meet with the surgeon and anesthesiologist to discuss the procedure and anesthesia options
  • Patient may be instructed to stop certain medications or adjust their diet in preparation for surgery
  • Patient may undergo pulmonary function tests to assess lung function
  • Patient may need to quit smoking and improve overall health before surgery

After lung surgery:

  • Patient is closely monitored in the recovery room for a few hours post-surgery
  • Patient may have a chest tube inserted to drain fluid and air from the chest cavity
  • Patient is encouraged to start moving and walking as soon as possible to prevent complications
  • Pain management is provided to ensure comfort during the recovery process
  • Patient may be discharged from the hospital within a few days, depending on the type of surgery and overall recovery progress
  • Patient will undergo follow-up appointments with the surgeon to monitor healing and recovery progress.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with lung surgery?
  2. How long is the recovery period after lung surgery and what can I expect during this time?
  3. Will I need to stay in the hospital after the surgery? If so, for how long?
  4. What are the chances of needing a blood transfusion during or after the surgery?
  5. How will the surgery affect my breathing and lung function in the long term?
  6. Will I need any additional treatments or therapies after the surgery, such as chemotherapy or radiation?
  7. Are there any specific lifestyle changes I should make before or after the surgery to improve my outcomes?
  8. How experienced are you in performing nonintubated anatomic segmentectomies?
  9. What is your success rate with this type of surgery?
  10. Are there any alternative treatment options to consider before proceeding with lung surgery?

Reference

Authors: Gálvez C, Bolufer S, Gálvez E, Navarro-Martínez J, Galiana-Ivars M, Sesma J, Rivera-Cogollos MJ. Journal: Thorac Surg Clin. 2020 Feb;30(1):61-72. doi: 10.1016/j.thorsurg.2019.09.003. PMID: 31761285