32484 Removal of lung, other than pneumonectomy; single segment (segmentectomy)

Name of the Procedure:

Segmentectomy
Common name: Lung segment removal
Technical/medical term: Pulmonary segmentectomy

Summary

A segmentectomy is a surgical procedure to remove a single segment of the lung, which is a smaller division of one of the lobes of the lung. This surgery is less extensive than a lobectomy and is often used to treat localized lung conditions.

Purpose

Medical Condition: The procedure is often performed to remove early-stage lung cancer, benign tumors, or damaged lung tissue due to other diseases like tuberculosis or infections.

Goals/Outcomes: The primary goal is to remove the affected lung segment while preserving as much healthy lung tissue as possible. This aims to improve breathing, eliminate diseased tissue, and prevent the spread of any malignancy.

Indications

• Early-stage lung cancer confined to a single segment.
• Benign lung tumors affecting a specific segment.
• Persistent lung infections localized to one segment.
• Lung damage from conditions such as tuberculosis.

Patient Criteria:

• Patients with good overall lung function.
• Those who cannot tolerate more extensive surgery like a lobectomy.
• Confirmation of localized disease via imaging and other diagnostic tests.

Preparation

• Fasting: Patients typically need to fast for 8 hours before surgery.
• Medication Adjustments: Certain medications, especially blood thinners, may need to be paused.
• Diagnostic Tests: Pre-procedure assessments may include a chest CT scan, blood tests, pulmonary function tests, and sometimes a PET scan to assess lung function and the extent of the disease.

Procedure Description

1. Anesthesia: General anesthesia is administered, ensuring the patient is asleep and pain-free.
2. Incision: A small incision is made in the chest to access the lung. This can be done via open surgery or minimally invasive techniques like video-assisted thoracic surgery (VATS).
3. Isolation of Segment: The surgeon identifies and isolates the targeted lung segment.
4. Removal: The blood vessels and bronchus supplying the segment are carefully cut and sealed, and the segment is removed.
5. Closure: The incision is closed with sutures or staples, and a drainage tube may be placed to remove air, blood, or fluid from the chest.

Tools/Equipment: Scalpel, surgical stapler, video-assisted thoracoscopic equipment (for minimally invasive procedures).

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity and approach used.

Setting

The procedure is generally performed in a hospital operating room.

Personnel

• Surgeon: Performs the procedure.
• Nurses: Assist during surgery and help with patient care before and after the procedure.
• Anesthesiologist: Manages anesthesia and monitors the patient's vital signs during surgery.

Risks and Complications

• Common Risks: Infection, bleeding, and pain at the surgical site.
• Rare Risks: Air leaks, pneumonia, and blood clots.
• Complications Management: Antibiotics for infections, drainage of any air or fluid buildup, and physical therapy to improve breathing.

Benefits

• Expected Benefits: Removal of diseased tissue, potential cure or control of lung cancer, and improved lung function.
• Realization Time: Benefits can often be seen within days to weeks after surgery as the lung heals and recovers.

Recovery

• Post-Procedure Care: Includes pain management, breathing exercises, and monitoring for complications.
• Recovery Time: Most patients can return to normal activities within 2 to 4 weeks, though complete recovery may take longer.
• Restrictions: Avoid heavy lifting and strenuous activities until cleared by the doctor. Follow-up appointments are necessary to monitor healing.

Alternatives

• Lobectomy: Removal of an entire lobe of the lung, preferred for larger or more extensive disease.
• Radiation Therapy: Non-surgical option using high-energy rays to target and kill cancer cells.
• Chemotherapy: Use of drugs to kill cancer cells.
• Pros and Cons: Lobectomy offers more extensive removal but involves more lung tissue loss. Radiation and chemotherapy are less invasive but may not be as effective for localized conditions.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not experience pain during surgery.
• After Procedure: Pain and discomfort can be managed with medications. Patients may feel shortness of breath initially but will improve with recovery and respiratory exercises.