32488 Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)

Name of the Procedure:

Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)

Summary

A completion pneumonectomy is a surgical procedure where the entire remaining lung is removed after a previous surgery in which only a portion of the lung was taken out.

Purpose

This procedure addresses severe lung diseases or conditions, such as advanced lung cancer, severe infections, or irreversible lung damage. The goal is to remove diseased tissue to prevent its spread, alleviate symptoms, and potentially improve the patient's quality of life.

Indications

• Advanced or recurrent lung cancer
• Severe or chronic lung infections
• Significant lung damage from previous surgery or disease
• Non-improving conditions that affect lung function after segmental lung resections

Preparation

• Fasting for at least 8 hours before surgery
• Discontinuing certain medications, as instructed by the healthcare provider
• Preoperative testing including blood work, imaging studies (like CT scans), pulmonary function tests, and cardiac assessments

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made on the side of the chest (thoracotomy).
3. Surgical tools, including retractors and a surgical saw, are used to expose the lung.
4. The remaining lung tissue and associated structures are carefully dissected and removed.
5. The bronchial stump is closed, and any blood vessels are sutured or stapled.
6. The chest is closed, and drainage tubes are placed to remove any fluids post-surgery.

Duration

The procedure typically takes 3-5 hours, depending on complexity.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Respiratory failure
• Bronchopleural fistula (abnormal connection between the bronchial tubes and pleural cavity)
• Complications related to anesthesia

Benefits

Successful removal of diseased lung tissue, potential for alleviation of symptoms, prevention of disease progression, and improvement in overall quality of life. Benefits may be realized over several weeks to months after surgery.

Recovery

• Initial hospital stay of 7-10 days, with close monitoring in the intensive care unit (ICU) initially.
• Pain management with medications.
• Breathing exercises and physical therapy to aid recovery.
• Follow-up appointments for wound checks, imaging, and pulmonary assessments.
• Gradual return to normal activities, typically within 6-8 weeks, with some restrictions.

Alternatives

• Chemotherapy or radiation therapy, particularly for cancer.
• Less invasive surgeries, such as segmental resection or lobectomy if applicable.
• Palliative care for symptom management without surgery.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel pain. Postoperatively, patients might experience pain or discomfort, managed with pain relief measures. Breathing exercises and physical therapy are crucial parts of recovery. The experience can be challenging, but structured pain management and support aim to ensure comfort and facilitate recovery.