LUNG AND CHEST CAVITY SURGERY.......

Surgery of the lungs and chest cavity

The department performs routinely all types of chest surgeries for diseases of the lungs, trachea, esophagus, diaphragm, chest wall and mediastinum. All the lung procedures are done with selective lung ventilation (right/ left).

Lung surgery involves making small or large incisions (thoracotomy) on the chest wall to view the lungs. Thoracoscopy and Thoracotomy are the two ways to perform lung surgery. The initial method involves small incisions on the chest wall and inserting thin tubes with cameras to view the lungs on a video monitor.

The second method is to make larger incisions on the chest wall to have a direct view of the lungs.

a) Wedge resection: A wedge resection is the surgical removal of a small portion of the diseased lung along with small portion of healthy tissue.                 

 b) Segmentectomy Includes removal of a segment of the lung.

c)Lobectomy:
A lobectomy is the removal of a lobe of the lung. The right lung has 3 lobes and the left lung has 2 lobes. A “bilobectomy” refers to the removal of 2 lobes. 

d) Pneumonectomy: A pneumonectomy involves the removal of an entire lung, A pneumonectomy is considered if a tumor is too large to be removed by the other methods available, or if the tumor is located in a more central location in the lung. Rib resection is usually done along with this for space reduction. 

e) Thymectomy: It is the removal of the thymus gland and is usually performed through median sternotomy. Thymus is dissected upto the root and mediastinal fat is also removed to exclude ectopic thymus. 

f) Excision of mediastinal tumors: Mediastinal tumor excision is done in case of mediastinal mass. Approach is either sternotomy or thoracotomy.

g) Hiatal hernia repair: The surgery is usually performed with an open approach using a standard incision just below the rib cage. The tissue and organs, if present, are placed back in the abdomen. Once the tissues are returned to their proper place, the hole in the diaphragm is closed. This is done to prevent the abdominal tissues from migrating back in to the chest cavity. If the defect in the diaphragm is very severe, a diaphragm may be created from synthetic materials.

h) Video Assisted thoracoscopic Surgery (VATS): VATS is a minimally invasive surgical technique used to diagnose and treat problems in the chest. VAT is performed using a small video camera that is introduced into the patient’s chest via a small incision. With the video camera, the surgeon is able to view the anatomy along with other surgical instruments that are introduced through small incision ports. Video-assisted thoracoscopic surgery (VATS) can be used for many purposes, ranging from a biopsy to removal of tumors or entire lobes from the lung. 

i) Pericardiectomy: Here constrictive pericardium is removed using a special cautery, harmonic scalpel cautery.

Prevention of infections

Disinfect OT before and after surgery.  The floor and walls of the OR is cleaned with disinfectant solution. The trolleys, machines, lights and all the equipment in the OR are disinfected with1/40 cetrimide.Terminal cleaning and disinfection is conducted at the end of the day. After each case, soiled linen are carefully handed over to the laundry department to get it washed for the next day use. The utensils are handed over to the CSSD through the unsterile lift in the unsterile zone. Instruments are washed in the ultra sonic washer using 3M proteolytic solution and are treated with instrument lubricant solution (aseptic-lube) to prevent corrosion. The washed instruments are dried in the drier, packed and send to the CSSR for autoclaving. Vascular instruments, which need particular care are handled only by the nurses. Used cannula, defibrillating paddles, cables and other heat labile items are sterilized usinghydrogen peroxide gas plasma steriliser in the STERRAD system daily after proper washing and drying. It sterilizes the instruments and medical devices safely and effectively, under low temperature, protecting the instruments, users, patients and the environment. Some items are also sent to the CSSR for ETO.In addition to daily cleaning, a thorough weekly cleaning and washing is followed every Saturday in the OR using vacuum cleaner. We also have air purifier which purifies air with combination of UV light + ozone+ atomizer. The UV radiation imparts a strong sterilizing power. Weekend fumigation is done with Hydrogen peroxide solution.  Microbiological Surveillance is done periodically. Fumigation is also planned after maintenance work or if any outbreak of infection.

Principles followed in undertaking surgery in an infected patient

Schedule the surgery as the last one. Minimise staff entry. Use minimum instruments. Use double gloves. Use disposable apron, gown, cap, mask and shoe cover. Protect eyes with goggles. Use maximum disposable supplies. Affix biohazard label to specimens. Disinfect spillage using 1% sodium hypochlorite solution. Avoid needle stick and sharp injury. Double bags for disposal of biohazard waste with label. Used linen should be immersed in 1% sodium hypochlorite solution for ½ an hour.  Double bag and label used linen before sending to laundry. Double autoclaving for used instruments and trays. Disinfect OT surfaces and equipment with 1% sodium hypochlorite solution. Fumigation is done after completion of surgery.

THANKS FOR VISITING MY BLOG...KEEP IN TOUCH.