What Happens During a Lobectomy Procedure

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A lobectomy is a lung cancer surgery in which one lobe of a lung is removed. It removes more lung tissue than a wedge resection, but less than a pneumonectomy.

When You Arrive

Prior to your lobectomy, you will talk to your surgeon and anesthesiologist about what will happen. This is a good time to ask any questions you may have. As noted in the article on preparing, you will likely have refrained from eating or drinking after midnight the night before the procedure. If you take any medications routinely, make sure to mention this to your anesthesiologist. While waiting, you will probably have an IV placed in your arm, and you may be given a medication to relax you.

During the Surgery

During your lobectomy procedure, your surgeon will remove the lobe of your lung that is affected by lung cancer. Depending upon the type of lobectomy procedure your surgeon recommends, your cancer may be removed through an open incision or through the use of instruments inserted through smaller incisions. Here's what will happen during your lobectomy procedure.

In the operating room, you will be given a general anesthetic to put you to sleep, and an endotracheal tube will be placed through your mouth to allow a ventilator to breathe for you during surgery.

Open vs. VATS Lobectomy

In an open lobectomy, a long incision will be made along your side following the curve of your ribs. The surgeon will spread your ribs and may remove a portion of a rib to gain access to your lung. The blood vessels (arteries and veins) and airways leading to the affected lobe are tied off, and the lobe is then removed. Prior to closing the incisions, your surgeon will insert a chest tube that will be left in place for a period of time. The chest tube allows excess blood and fluids to drain following surgery and will be removed when the drainage has stopped.

With a VATS lobectomy, surgeons make several small incisions on your chest through which they can insert instruments and a small video camera (a thoracoscope). The camera projects an image onto a video screen that allows the surgeons to see the area they are working on. The blood vessels and airways to the involved lobe are tied off with the use of these instruments, and the lobe is removed through one of the incisions. Following removal of the lobe, surgeons may also biopsy or remove lymph nodes in the area near the tumor. A chest tube may or not be inserted into your chest following the surgery.

A robotic VATS lobectomy may be another option at some cancer centers and appears to be both safe and effective in clinical trials thus far.

Sometimes surgeons encounter problems during a VATS lobectomy, such as bleeding or a tumor that cannot be adequately removed. In this case, the procedure may need to be converted to open lobectomy.

When Your Surgery Is Done

When your surgery has been completed, you will usually be taken to the recovery room for an hour or two. During this time you will be monitored closely for any bleeding or pain as you begin to wake up. Depending on how you do with surgery as well as the surgeon's preference, you will then be taken to either the intensive care unit or a surgical floor. Most of the time your family will be allowed to see you and visit when you arrive back in your room, but this can vary between institutions.

Choosing a Surgeon

It's important to think carefully about your lobectomy before the procedure. It's been found that hospitals that perform greater volumes of lung cancer surgery have better outcomes. For you, that might mean fewer complications or more effective removal of cancerous lung tissue. Here are some tips on how to choose a cancer center.

Strongly consider getting a second opinion. Not all surgeons are comfortable performing surgeries such as VATS lobectomy. While this approach cannot always be taken, it's worth considering (and finding a surgeon who performs this technique) as it is a less invasive procedure with an easier recovery most of the time. Your surgeon will not be upset if you request a second opinion, and in fact, most surgeons expect that patients will do so. You may wish to consider one of the larger National Cancer Institute-designated cancer centers for a second opinion, as some of these centers are more likely to have surgeons on staff who specialize in lung cancer surgery.

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