Lobectomy Surgery in Delhi, India

The lobe of the lung can be removed using different types of procedures. Each procedure has a different preparation technique, recovery process, complications, and prognosis. Deciding the kind of lobectomy depends on the location and size of the tumour. The three types of lobectomy procedures are:

1. Open lobectomy: In an open lobectomy, incisions are made on the side of the chest to remove the lobe of the lung. This technique involves spreading the ribs to remove the lobe.
2. Video assisted thoracoscopic surgery (VATS): In this method, the lobe is removed through the small incisions in the chest using tools and a camera. This type of lobectomy causes fewer complications than an open lobectomy.
3. Robot-assisted thoracoscopic surgery: This surgery is similar to video-assisted lobectomy and is performed using robotic technology. This procedure causes fewer complications and is a more technically involved procedure.

Lobectomy surgery is needed when a problem is detected in any lobes. The affected lobe is removed through surgery to prevent the spread of disease to other lobes and nearby tissue.

Lung diseases that can be treated with lobectomy include:

• Tuberculosis (TB): Tuberculosis is a chronic bacterial infection that causes lung infection. Post-tubercular fibrotic lung disease causing recurrent infection or blood in spectrum can be treated this way.
• Benign tumour: This is a non-cancerous tumour. The tumour can press on blood vessels and affect the functioning of the lungs and other organs.
• Lung abscess: Lung abscess refers to a cavity filled with pus in the lungs. It is caused by bacterial infection, which makes the lung tissue die.
• Lung cancer: Lung cancer affects the bronchi (the main airways), lobes of the lungs, lung tissue, or the pleural lining. If not treated, cancer can spread to other body parts.
• Fungal infection: If fungus grows in the lungs, it can cause infections and complications.

These lung diseases can spread to the surrounding lobes and other body parts and affect lung functioning. Surgery is needed to remove the infected part and maintain lung function in such cases.

Before lobectomy treatment, the doctor can ask the patient about their medical history and conduct a physical examination. Other tests, such as blood tests and breathing tests, can be performed. A breathing test is conducted to determine the patient's ability to breathe comfortably after the surgery.

The doctor will also review the medications and may recommend stopping a few medicines before surgery.

Before the surgery, the doctor will explain the types of procedures and risks involved. While preparing for surgery, the doctor will recommend the following:

• Stop smoking to reduce the risk of complications and improve the healing process
• Practice breathing exercises for post-surgery care
• Stop taking medication that causes blood thinning

During a lobectomy, an incision is made at the level of the affected lobe. The incision is made in front of the chest, under the nipple. The surgeon accesses the chest cavity, and the lobe is removed through the exposed ribs.

Before Lobectomy Surgery:

• An IV line will be inserted in the arm
• The surgeon will give local or general anaesthesia to numb the area
• A breathing tube will be inserted into the throat and hooked to a ventilator. A catheter may be inserted to drain urine during and after the surgery
• The patient's heart rate, breathing, and blood pressure will be monitored throughout the surgery
• The area is cleaned with an antiseptic solution, followed by an incision

If a patient is undergoing open lobectomy:

• An incision is made in front of the chest at the level of the affected lobe to remove it. The cut goes from the chest, under the arm, and around the back
• The ribs will be spread apart with a special tool, and the lobe will be removed
• The surgeon may put one or more tubes in the chest to remove air and fluid after surgery
• The incision will be stitched, and a bandage or dressing will be applied to the area

If a patient is undergoing video thoracoscopic surgery 

• Two or three small incisions are made near the area of the lobe
• A thoracoscope (a small tube with a light and tiny camera) is inserted into the chest cavity
• This device sends images to the computer screen that helps the surgeon examine the area
• The surgical instrument will be inserted through another incision to remove the lobe or its tissue
• A test tube is placed in the surgical area to drain excess fluid and air from the chest
• The incision will be stitched and bandaged

If a patient is undergoing robots assisted thoracoscopic surgery:

• Three or four small incisions will be made near the area of the lobe
• Similar to video-assisted surgery, the thoracoscope is inserted through one cut into the chest cavity to view the inside of the chest cavity
• A robotic instrument controlled by the surgeon will be inserted through another incision
• The magnified view and robotic instrument help the surgeon precisely remove the lobe tissue from the small incision
• A test tube will be placed in the surgical area to drain excess fluid and air from the chest
• The incision will be stitched and bandaged

Antibiotics may be given before and after the procedure to reduce the risk of infections.

Like any other surgical procedure, lobectomy can lead to bleeding or infections. The treatment can cause complications like leakage in the lung, and the patient will need a drainage tube for a long duration. The leak heals on its own and does not require further treatment.

The risk and complications of the surgery include:

• Infection and bleeding
• Lung collapse due to air in the lung's pleural space
• Pus in the chest cavity
• Fluid in the lung and inner chest wall
• Air or fluid leakage into the chest due to a tube-like opening between a bronchus and pleural space

Other major complications due to lobectomy include:

• Heart attack
• Stroke
• Risks due to general anaesthesia
• Blood clots
• Pneumonia

A person may also experience Post Thoracotomy Pain Syndrome, a condition in which a person experiences persistent chest pain for years after lung surgery.

Keep the dressing clean and dry. Follow the bathing instructions given by the surgeon. After surgery, the patient will also be taught deep breathing exercises and coughing methods to expand the lungs. Before taking any medicine, consult the doctor. 

While healing at home, makes sure to avoid exposure to:

• Air pollution
• Tobacco smoke
• Chemical fumes
• Infections such as cold or flu

• Da Vinci-The Next Level Technology in Surgical Excellence and Patient Safety
• Understanding Tuberculosis