Canis ISSN: 2398-2942

Lung: lobectomy

Contributor(s): Gerry Polton, D M Tillson

Introduction

  • Removal of a damaged, neoplastic or infected lung lobe should improve survival and in some cases result in the resolution of disease. Lobectomy is also used for combined diagnostic and therapeutic gain in some cases though less invasive techniques must also be considered.

Uses

Advantages

  • Most straightforward surgical technique for dealing with localized lung problems.

Disadvantages

  • Reduces the overall functional volume of the lungs.
  • Thoracic surgery in general requires a higher level of expertise and experience than other surgeries due to:
    • Limited exposure.
    • Need for intraoperative ventilatory support.
    • Potential for higher than normal nursing care after surgery.
      Avoid removing more than 50% of the lung tissue in a single procedure.
  • Positioning of the incision is critical to success.
  • Ribs will limit exposure to the underlying organs.
  • Ribs can be retracted more cranially, so better to make the incision more caudally if unsure of the appropriate intercostal space Lobectomy - ICS table.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Depends on the reason for thoracotomy:
    • Good prognosis for pulmonary abscess and foreign bodies.
    • Guarded prognosis for bullae.
    • Solitary lung masses can be cured by surgery:
      • Tumor must be confined to a single lobe.
      • Lymph node metastasis and infiltration into pleura will result in death from the cancer.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Polton G A, Brearley M J, Powell S M et al (2008) Impact of primary tumour stage on survival in dogs with solitary lung tumours. JSAP 49 (2), 66-71 PubMed.
  • Murphy S T, Ellison G W, McKiernan B C et al (1997) Pulmonary lobectomy in the management of pneumonia in dogs: 59 cases (1972-1994). J Amer Vet Assoc 210 (2), 235-239 PubMed.
  • Tillson D M (1997) Thoracostomy tubes. Part I Indications and anesthesia. Comp Contin Ed 19 (11), 1258-1267 VetMedResource.
  • Tillson D M (1997) Thoracostomy tubes. Part II Placement and maintenance. Comp Contin Ed 19 (12), 1331-1338 VetMedResource.
  • Thompson S E & Johnson J M (1991) Analgesia in dogs after intercostal thoracotomy; A comparison of morphine, selective intercostal nerve block and interpleural regional anesthesia with bupivacaine. Vet Surg 20 (1), 73-77 PubMed.
  • Pavletic M M (1990) Surgical stapling devices in small animal surgery. Comp Contin Ed 12 (12), 1724-1741 VetMedResource.
  • LaRue S M, Withrow S J & Wykes P M (1987) Lung resection using surgical staples in dogs and cats. Vet Surg 16 (3), 238-240 PubMed.


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