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Surgical Technology
6th edition
CHAPTER 33
Thoracic and Pulmonary Surgery
Copyright ©2013 by Elsevier Inc. All rights reserved
Lesson 33.1
Anatomy, Case Planning, and Procedures
1.
2.
3.
4.
5.
Identify key anatomical features of the respiratory
structures in the thoracic cavity.
Describe diagnostic procedures of the respiratory
system.
Discuss pathology of the respiratory system.
Discuss specific elements of the case planning in
surgery of the thoracic cavity and respiratory
system.
List and describe common thoracic procedures of
the respiratory system.
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Terminology Review
Review terms and definitions listed at
beginning of chapter
 Use your medical dictionary if necessary

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Respiratory Function
Ventilation
 Diffusion
 Perfusion

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The Upper Respiratory Tract
Nose composed of cartilage and bone
 Internal and external nose
 Nasal sinuses: conchae or turbinates

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The Pharynx and Larynx
Pharynx lies behind the oral cavity
 Divided into three sections
 Larynx connects trachea to oropharynx
 Larynx contains the epiglottis

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The Bronchi
Left and right primary
 Branch off at the carina
 Become bronchioles
 Terminate at the alveoli

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The Bronchioles
From Herlihy B, Maebius NK: The human body in health and illness, ed 2, Philadelphia, 2003, WB Saunders.
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The Lungs
Paired organs separated by the mediastinum
 Enclosed in the pleural cavity
 Covered by the pleural sac
 Expand based on negative pressure created by
the space between the two layers
 Break in integrity of pleural cavity causes a
collapse

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Mechanism of Breathing
Controlled by the autonomic nervous system
 Diaphragm contracts, decreasing space
between pleural membranes
 Thoracic cavity is a closed space

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Factors Affecting Breathing
Intact pleural membrane maintains negative
space
 Penetrating trauma causes lungs to collapse
 Sufficient elasticity of alveoli
 Intact central nervous system
 Chest cavity expansion

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Diagnostic Testing
Pulmonary function
 Laboratory test
 Imaging studies

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Instruments
General surgery instruments
 Chest wall instruments
 Lung instruments
 Bronchus clamps
 Surgical stapling devices
 Vascular clamps

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Instruments (Cont.)
From Tighe SM: Instrumentation for the operating room, ed 6, St Louis, 2003, Mosby.
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Closed Chest Drainage
From Lewis SM, Heitkemper MM, Dirksen SR: Medical surgical nursing, ed 6, St Louis, 2004, Mosby.
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Bronchoscopy
From Sugarbaker DJ, Strauss G, Fried MP: Laser resection of endobronchial lesions: use of rigid
and flexible bronchoscopes, Operative techniques in otolaryngology—head and neck surgery
3:93, 1992.
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Mediastinoscopy
Endoscopic examination of the mediastinum
through
incision
 Thymus and lymph node biopsy are
performed to establish a diagnosis

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Video-Assisted Thoracoscopic Surgery
Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.
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Patient Position
Lateral with an axillary roll
 Anesthetic



General
Trocar placement

Dependent upon procedure
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Lung Biopsy
Removal of a small portion of lung tissue for
pathological examination
 Performed when other diagnostic tests are
inconclusive
 Completed as a video-assisted procedure

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Lung Volume Reduction Surgery
Patients with chronic pulmonary emphysema
may benefit
 Involves resection of portions of a lung in
which air is trapped in emphysematous lung
tissue

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Thoracotomy

Open surgery of the thoracic cavity
Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.
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Thoracotomy (Cont.)
Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.
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Lobectomy
Removal of a lobe of the lung to prevent the
spread of metastatic cancer or to treat a
benign tumor
 May be performed as video-assisted
procedure

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Lobectomy (Cont.)
Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby.
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Pneumonectomy
Procedure involves removal of entire lung
 Procedure done to

Debulk malignant tumor
 Slow spread of cancer
 Treat extensive abscess
 Treat bronchiectasis

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Rib Resection:
Thoracic Outlet Syndrome
Thoracic outlet syndrome is compression of
subclavian vessels and brachial plexus at
superior aperture of thorax
 Decompression includes partial or entire
removal of rib

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Decortication of the Lung
Surgical removal of fibrin layer of the lung to
facilitate lung expansion
 Surgical removal of a portion of the parietal
pleura

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Lung Transplantation

Performed to remove diseased, poorly
functioning lung and replace with lung from
organ donor
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Lung Transplant Indications
Restrictive lung disease
 Emphysema
 Pulmonary hypertension
 Other noninfectious end-stage pulmonary
diseases

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Single and Bilateral Lung Transplants

In single-lung transplant, surgeon will make
three anastomoses:
Bronchus to bronchus
 Pulmonary artery to pulmonary artery
 Recipient pulmonary veins to donor atrial cuff


In bilateral transplant

May require cardiopulmonary support
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Questions?
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