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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. Copyright ©2013 by Elsevier Inc. All rights reserved Terminology Review Review terms and definitions listed at beginning of chapter Use your medical dictionary if necessary Copyright ©2013 by Elsevier Inc. All rights reserved Respiratory Function Ventilation Diffusion Perfusion Copyright ©2013 by Elsevier Inc. All rights reserved The Upper Respiratory Tract Nose composed of cartilage and bone Internal and external nose Nasal sinuses: conchae or turbinates Copyright ©2013 by Elsevier Inc. All rights reserved The Pharynx and Larynx Pharynx lies behind the oral cavity Divided into three sections Larynx connects trachea to oropharynx Larynx contains the epiglottis Copyright ©2013 by Elsevier Inc. All rights reserved The Bronchi Left and right primary Branch off at the carina Become bronchioles Terminate at the alveoli Copyright ©2013 by Elsevier Inc. All rights reserved The Bronchioles From Herlihy B, Maebius NK: The human body in health and illness, ed 2, Philadelphia, 2003, WB Saunders. Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved Mechanism of Breathing Controlled by the autonomic nervous system Diaphragm contracts, decreasing space between pleural membranes Thoracic cavity is a closed space Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved Diagnostic Testing Pulmonary function Laboratory test Imaging studies Copyright ©2013 by Elsevier Inc. All rights reserved Instruments General surgery instruments Chest wall instruments Lung instruments Bronchus clamps Surgical stapling devices Vascular clamps Copyright ©2013 by Elsevier Inc. All rights reserved Instruments (Cont.) From Tighe SM: Instrumentation for the operating room, ed 6, St Louis, 2003, Mosby. Copyright ©2013 by Elsevier Inc. All rights reserved Closed Chest Drainage From Lewis SM, Heitkemper MM, Dirksen SR: Medical surgical nursing, ed 6, St Louis, 2004, Mosby. Copyright ©2013 by Elsevier Inc. All rights reserved 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. Copyright ©2013 by Elsevier Inc. All rights reserved Mediastinoscopy Endoscopic examination of the mediastinum through incision Thymus and lymph node biopsy are performed to establish a diagnosis Copyright ©2013 by Elsevier Inc. All rights reserved Video-Assisted Thoracoscopic Surgery Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby. Copyright ©2013 by Elsevier Inc. All rights reserved Patient Position Lateral with an axillary roll Anesthetic General Trocar placement Dependent upon procedure Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved 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. Copyright ©2013 by Elsevier Inc. All rights reserved Thoracotomy (Cont.) Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby. Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved Lobectomy (Cont.) Modified from Waldhausen JA, Pierce WS, Campbell DB: Surgery of the chest, ed 6, St Louis, 1996, Mosby. Copyright ©2013 by Elsevier Inc. All rights reserved Pneumonectomy Procedure involves removal of entire lung Procedure done to Debulk malignant tumor Slow spread of cancer Treat extensive abscess Treat bronchiectasis Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved Lung Transplantation Performed to remove diseased, poorly functioning lung and replace with lung from organ donor Copyright ©2013 by Elsevier Inc. All rights reserved Lung Transplant Indications Restrictive lung disease Emphysema Pulmonary hypertension Other noninfectious end-stage pulmonary diseases Copyright ©2013 by Elsevier Inc. All rights reserved 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 Copyright ©2013 by Elsevier Inc. All rights reserved Questions? Copyright ©2013 by Elsevier Inc. All rights reserved