Pulmonary surgery means all surgical procedures of the chest and lungs. These include both benign conditions, such as a collapsed lung, and malignant conditions, such as lung cancer.
Within the Jan Yperman Hospital, we wish to approach all lung pathology in a multidisciplinary manner. To this end, we work closely with other specialists such as pulmonologists, oncologists and radiologists. On this website, we would like to discuss the technical aspects of your operation in more detail.
In recent years, there has been a very rapid evolution in the way lung surgery is performed. Whereas in the past a large incision was made, the procedure is now performed using one to three small incisions. We call this procedure thoracoscopy or keyhole surgery. In addition, all care before and after your procedure is organised according to a specific care path. We have been successfully using the ERAS programme for several years. ERAS is an abbreviation for Enhanced Recovery After Surgery. This is a quality programme for the time around an operation that brings together all the factors that have a positive influence on your recovery.
1/ Quality care before the operation
The entire perioperative course will be discussed with you by your attending physician.
Assessing the risk of the procedure and optimising the general condition:
Besides the extent of the operation, your general condition also determines how successful your recovery will be. Your doctor will assess your general condition on a clinical basis and on the basis of functional tests. We often see that the disease and/or previous treatments reduce the patient’s appetite and activity level. If necessary, it will be suggested that you increase your activities before the operation itself or that you follow a short rehabilitation schedule. Nutritional advice may also be given.
Each patient is referred to our physiotherapist before the operation. Specific breathing exercises are taught during the sessions that will help you in your post-operative recovery.
To optimise your lung function, we ask you not to smoke and to limit alcohol consumption for 4 weeks prior to the procedure.
Preoperative consultation with the anaesthetist
At the Jan Yperman Hospital, we provide a preoperative check-up by the anaesthesia department. This way, you get all the explanations about the medication to be taken or not to be taken. And your record will be fully prepared for the procedure.
2/ Quality care on the day of surgery:
Avoiding prolonged fasting
Solid food may be taken up to 6 hours before the procedure. In practice, we ask you not to eat after midnight. You may drink water up to 2 hours before the procedure.
Checklist
On the day of the operation, we will go over a checklist with you at several moments in time. You may have to answer the same questions several times. This is to optimise patient safety. In this context, a “time-out” procedure is carried out with the whole team just before the intervention.
Anaesthesia
The procedures takes place under full anaesthesia. You will be woken up in the operating theatre immediately after the procedure.
Pain relief and catheters
Avoiding pain after the procedure is very important. Pain impedes proper ventilation of the lower parts of the lung, especially in bedridden patients. Mobilisation and adequate pain relief are therefore very important for a smooth recovery.
When removing a complete lobe of the lung (lobectomy), an epidural catheter is inserted. This is done in the operating theatre while you are awake. The advantage is that local analgesia is administered at the chest wall. A bladder catheter and an arterial catheter are inserted at the wrist under anaesthesia. If the lobe is removed through a single incision of about 7 cm, an epidural catheter may not be inserted.
When removing a small piece of lung tissue, also called a wedge resection, no epidural catheter is inserted. After all, this intervention is short and not very invasive. During the procedure, a “paravertebral block” is placed by the anaesthetist or the surgeon. With this technique, the chest wall is also locally anaesthetised, but only for a few hours. The advantage of this technique is that it is not necessary to insert a bladder probe. In a wedge resection, only 2 peripheral infusions are inserted.
Minimally invasive technique: keyhole surgery
At the Jan Yperman Hospital, all lung operations are generally performed via keyhole surgery.
In case of a wedge resection, two incisions of about two cm are made. During a lobectomy, two small incisions of 1.5 cm and 5 cm are made as standard.
Awakening
You will be woken up in the operating theatre immediately after the procedure. After a lobectomy, you will be taken to the intensive care unit for one night. After a wedge resection, you are taken to the recovery room. After about two hours you will be taken to your room.
Food and drinks
The ERAS programme contains a number of elements aimed at preventing post-operative nausea. Yet it cannot always be prevented.
After waking up, you may drink a little water. If this goes well, a light meal can be had about six hours after the procedure. You will feel whether you are able to eat.
Mobilisation
Two hours after the operation, you will do breathing exercises in bed together with the physiotherapist. During the operation, no air is left in the operated lung. It is important that this is opened properly again after the procedure. If feasible, you will sit up in the chair the evening of the operation.
3/ Quality care in the days after surgery
Food and drinks
You may eat and drink normally the day after the procedure.
Catheters and drains
To promote mobility, we aim to remove infusions, catheters and drains as soon as possible. Of course, we take your clinical condition into account.
After a lobectomy, some air may temporarily leak from the operated lung. We call this an air leak. In the majority of patients, this air leak disappeared after two days. The chest drain is therefore removed after two days. Since the presence of a chest drain between the ribs causes pain, the epidural catheter, as well as the bladder catheter and infusion will remain in place until after the drain is removed. The epidural catheter is removed after the third day at the latest.
In the case of a wedge resection, the chest drain is removed the day after the operation, depending on a possible air leak. The infusion is also removed. The day after the operation, you will be catheter-free in principle. Pain relief is administered in pill form.
Mobilisation
The day after the operation, you will start walking in the corridor under the supervision of the physiotherapist. Before discharge, you will do stairs with the physiotherapist.
Discharge
After a wedge resection, you can leave the hospital after three days. After a lobectomy after about five days. Of course, every patient and every procedure is unique and the duration of hospitalisation may therefore differ.
You may leave the hospital if the following conditions are met
4/ Quality care after discharge
In principle, you need little extra care at home. On discharge, you can walk and carry out light household chores. You may also go outside the house. Although the procedure is minimally invasive and hospitalisation is short, a recovery period should still be taken into account. This is about four weeks after a wedge resection and about three months after a lobectomy. It is very important that you work on your condition daily. You can do this by walking, cycling on an exercise bike... Try to find your daily rhythm again as soon as possible, but bear in mind that you will be more tired.
Upon discharge, the result of the microscopic examination may not yet be known. A consultation with the treating pneumologist is scheduled after two weeks to discuss the result and the need for additional therapy. A check-up with the surgeon is scheduled after four weeks.
5/ Complications
Air leak
When part of the lung is removed, a wound is made on the remaining lung tissue. Air may possibly leak out after the procedure, which is removed from the chest cavity via the chest drain. If the air were to accumulate in the chest cavity, it would result in a collapsed lung. Therefore, the chest drain cannot be removed as long as an air leak is present. The vast majority heal spontaneously and do not require further surgical intervention.
Bleeding
Fortunately, a haemorrhage is rare, but it is always possible. For example, one of the wounds can continue to bleed.
Pneumonia
During the procedure, no air is let into the lung, causing the lung to fall flat. After the operation, the lung should be allowed to fully develop again. In bedridden patients, the lower parts of the lung are less ventilated. Especially after a lung operation, a real chance of developing pneumonia exists in this case. It is therefore very important to mobilise quickly after the operation. As described above, you will be given breathing physiotherapy and sit up in an armchair the day of the operation.
DVT and pulmonary embolism
In case of prolonged immobilisation after the procedure, clots may form in the veins of the legs. As a preventive measure, you will be fitted with TED stockings and given injections in the abdomen after the procedure.
Arrhythmia
Since the lungs are located next to the heart, the heart's circulation may be somewhat disturbed shortly after the operation. This can lead to irregular heart rhythms and palpitations. If this is the case, your heart rhythm will be monitored in the room via telemetry. In most cases, heart rhythm can be normalised with medication.
Wound infections
These are rare. Some redness may occur at the chest drain site, but this is usually due to friction and is not based on infection. After removal of the chest drain, some pleural fluid may leak from the wound. This should have stopped at the time of discharge. If the wound is still leaking after discharge, please contact your surgeon.
6/ Contact in case of problems
If, after discharge, you experience pain that hinders your normal functioning, you have a fever or your general condition deteriorates, we recommend that you contact your attending surgeon.
If you have any further questions, you can always contact the doctor or oncologist concerned.
