Pneumonectomy

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. It was first successfully performed in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung.

There are two types of pneumonectomy: simple and extrapleural. A simple pneumonectomy removes just the lung. An extrapleural pneumonectomy also takes away part of the diaphragm, the parietal pleura, and the pericardium on that side.^[1]

Indications

The most common reason for a pneumonectomy is to remove tumorous tissue arising from lung cancer. Other reasons can arise are a traumatic lung injury, bronchiectasis, tuberculosis, a congenital defect, and fungal infections.^[2]

Contraindications

Tests

The operation will reduce the respiratory capacity of the patient, and before conducting a pneumonectomy, survivability after the removal has to be assessed. If at all possible, a pulmonary function test (PFT) should be done. It has been found that forced expiratory volume in one second (FEV1) and diffusion capacity of the lungs (DLCO) provides the best indicator of survival.^[3] Other tools can be used to assess effectiveness as well, such as cardiopulmonary exercise testing to measure maximal oxygen consumption (VO₂ max), stair climbing, shuttle walk test, and a 6-minute walk test.^[4]

Pathologies

If someone has severe valvular disease, severe pulmonary hypertension, or poor ventricular function or if cancer has spread from the lungs into the other intra-abdominal structures, ribs, or contralateral hemithorax, it is contraindicated.^[5]

Surgical approach

Posterolateral thoracotomy using the fourth or fifth intercostal space is the most common approach used for pneumonectomy. In case of inflammatory and infectious indications, excision of the fifth rib may be necessary to achieve adequate surgical exposure if there is rib crowding.^[6]

Video-assisted thoracoscopic surgery (VATS) approach: VATS pneumonectomy is a safe and feasible treatment for advanced malignant and benign diseases and has lower morbidity.^[7]

Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With a sound technique most procedures can be completed robotically without any major complications.^[8]

Anatomical changes

After a pneumonectomy is performed, changes in the thoracic cavity occur to compensate for the altered anatomy. The remaining lung hyperinflates as well as shifting over along with the heart towards the now empty space. This space is full of air initially after surgery, but then it is absorbed, and fluid eventually takes its place.^[9] The fluid which fills the residual space in the chest cavity slowly gelatinizes into a proteinaceous material, and the chest scaffold collapses slightly.^{[citation needed]}

Living with one lung

As with the

• Cardiac arrhythmias[12]
• Pulmonary complications like pneumonia, atelectasis, respiratory failure^[13]
• Bronchopleural fistula^[14]
• Injury to the diaphragm, liver, spleen, or a major vessel
• Postpneumonectomy pulmonary edema^[15]
• Postpneumonectomy cardiac herniation^[16]

History

Pioneering dates

• 1895: first pneumonectomy in multiple stages by William Macewen on a patient with tuberculosis and emphysema^{[citation needed]}
• 1912: first anatomical dissection lobectomy by Hugh Morriston Davies^[17]
• 1918: first successful lobectomy, by Harold Brunn^[18]
• 1931: first successful pneumonectomy in two stages by Rudolph Nissen on a patient with crush injury to the thorax
• 1933: first successful single-stage total pneumonectomy by Graham and Singer^[19]
• 1939: first segmentectomy, by Churchill and Belsey^[20]

See also

• Medical ventilator
• List of surgeries by type

References

External links

Wikimedia Commons has media related to Pneumonectomy.

• Fuentes PA (April 2003). "Pneumonectomy: historical perspective and prospective insight". Eur J Cardiothorac Surg. 23 (4): 439–45.
  PMID 12694756
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