Lung Surgery
Lung surgery usually involves
operations on one lung for an abnormal finding on a chest x-ray. The
one at left shows a mass in the left lung. These abnormalities may be
either benign (not cancer) or malignant (cancer). 
The
doctor will most likely perform a CT scan like the one at left showing
a mass in the left lung. The CT scan further defines the presence, size,
character, and position of the abnormality found on chest x-ray. The
CT scan can also determine whether lymph nodes in the center of the
chest (called the mediastinum) are enlarged or are excessively numerous
and matted together.
During the work-up for a
lung mass, numerous other tests may be performed. These depend on individual
factors unique to each patient. At right is a representation of test
called a PET scan which can help doctors tell whether a mass is more
or less suspicious for cancer, and whether there might be spread of
cancer to lymph nodes or other areas outside of the chest. Once it has
been determined that the lung mass should be removed, the patient will
ususally undergo pulmonary function tests to determine the presence
and severity of emphysema or other conditions that would limit the patient's
ability to breath comfortably after surgery. The type of surgery the
patient undergoes is dictated by the type, size, and position of the
mass within the lung.
Each lung is divided
into lobes: two on the left (upper and lower) and three on the right
(upper, middle, and lower). The trachea and bronchi form an inverted
tree to give bronchial branches to each lobe. Each lobe has further
divisions called segments, with each segment getting its own bronchus.
Depending on the patient and the lung mass, there are generally four
ways to remove the mass, as depicted in the drawing at left. These are,
in order of least to most lung tissue removed: wedge resection, segmentectomy,
lobectomy, pneumonectomy. A small mass in the periphery of the lung
can be removed using stapling and cutting devices. This wedge resection
removes the mass with a surrounding layer of unaffected lung tissue.
A segmentectomy removes more lung tissue than a wedge resection, and
it involves removing the associatedsegmental bronchus. In a lobectomy,
an entire lobe of a lung with its associated lobar bronchus is removed.
A pneumonectomy removes the entire lung on one side. Lung procedures
can be performed through either a minimally invasive approach, called
video assisted thoracic surgery or thoracoscopy,
or through a larger incision with seperation of the ribs, called a thoracotomy.
The best approach depends on the patient and his or her particular clinical
problem.