32486 Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)

Name of the Procedure:

Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy)

Summary

A sleeve lobectomy is a surgical procedure where a lobe of the lung is removed along with a portion of the bronchus, in cases where the cancer or disease is localized to these areas. The dismantled bronchus is then reconnected to the remaining portions to ensure proper airway function.

Purpose

This procedure addresses lung cancer or other localized diseases within a lung lobe and part of the bronchus. The goal is to remove the diseased tissue while preserving as much lung function as possible.

Indications

• Lung cancer localized to a single lobe, extending into the bronchus
• Carcinoid tumors
• Other localized lung diseases not involving the entire lung

Patient criteria include:

• Adequate lung function
• Good overall health to tolerate surgery
• No widespread disease that would negate the benefits of localized resection

Preparation

• Fasting for at least 8 hours before surgery
• Cessation of certain medications as instructed by the physician
• Preoperative imaging tests like CT scans or MRIs
• Pulmonary function tests and overall fitness assessment

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest (thoracotomy) to access the lung.
3. The diseased lung lobe and the affected segment of the bronchus are removed.
4. The remaining bronchus segments are carefully sutured together (broncho-bronchial anastomosis).
5. The chest incision is closed, and a chest tube may be inserted to drain fluids.

Duration

The procedure typically takes about 3-6 hours, depending on individual circumstances and complexity.

Setting

Performed in a hospital operating room equipped for thoracic surgery.

Personnel

• Thoracic surgeon
• Surgical nurses
• Anesthesiologist
• Respiratory therapist (if needed)

Risks and Complications

• Bleeding
• Infection
• Air leaks
• Bronchial stenosis (narrowing of the bronchus)
• Pneumonia
• Anesthesia-related complications

Benefits

• Potential cure or significant control of localized lung cancer
• Preservation of more lung function compared to a pneumonectomy
• Improved quality of life and lung capacity

Recovery

• Typically requires a hospital stay of 5-7 days
• Pain management with medications
• Breathing exercises and physical therapy
• Restrictions on heavy lifting and strenuous activities for 4-6 weeks
• Follow-up appointments to monitor recovery and lung function

Alternatives

• Pneumonectomy (removal of an entire lung)
• Non-surgical treatments like radiotherapy or chemotherapy, though less effective for localized cases
• Laser therapy or bronchoscopic interventions for smaller, less invasive tumors

Patient Experience

Patients will be under general anesthesia and not experience pain during the surgery. Postoperatively, they may experience discomfort, pain, and soreness in the chest area, managed by pain medications. Gradual improvement in breathing and capabilities is common, with full recovery spanning 6-8 weeks.