Thoracic Surgery

By Mike Poullis

Overview

• What is it ?

• What do you need to know as a nurse on the ward ?

What do you need to know as a nurse on the ward ?

• Different pathologies

• Different operations

• Chest drains

• Post operative care

Different pathologies

• Lung cancer• Pneumothorax• Pleural effusions• Lung biopsies

• Trauma• Oddities

Different operations• Bronchoscopy (oesophagoscopy)• Mediasteinoscopy• Mediasteinotomy / Chamberlains• Thoracoscopy VATS• Mini thoracotomy• Full thoracotomy

• Pneumonectomy / Lobectomy / Wedge

Anatomy

• Trachea

• 2 bronchi

• 2 Lungs

• 3 lobes on left

• 2 lobes on right

The Right Lung

The Left Lung

Bronchial system

Lung cancer

• Small cell

• Non small cell– Squamous– Adeno– Large cell– Undifferentiated

Lung cancer

• Except for small cell carcinoma of the lung it is generally accepted that surgery is the most effective therapy for lung carcinoma

Small Cell Lung Cancer

Assessment of Patient

• Fitness for surgery

• Operability of the tumour - Staging

Staging

• TNM

• T size and position of tumour

• N lymph node status

• M metastasis

Stage IA of Lung Cancer

Stage IB of Lung Cancer

Stage IIA of Lung Cancer

Stage IIB of Lung Cancer

Stage IIIA of Lung Cancer

Stage IIIB of Lung Cancer

Stage IV of Lung Cancer

IV: Any T, Any N,M1

Synchronous tumours in different lobes are M1

Fitness for Surgery

• Age

• Pulmonary function

• Cardiovascular function

• Medical conditions

• Nutritional Status

• Performance status

Assessment of Operability

• CT scan

• Bone scan

• PET scan

• Mediastinoscopy

• Anterior Mediastinotomy

• VATS

Bronchoscopy

oesophagoscopy

Mediastinoscopy

Mediastinotomy / Chamberlains

Mediastinotomy

Thoracoscopy

Video Assisted Thoracic Surgery

Thoracotomy

Thoracotomy - Posterolateral

Thoracotomy - Anterolateral

Mini thoracotomy

• Small incision thoracotomy

Lung Resection

• Pneumonectomy

• Lobectomy

• Wedge

Lung Resection – Pneumonectomy

Lung Resection – Lobectomy (RUL)

Lung Resection – Lobectomy (RUL)

Wedge resection

Pleural effusions

• Fluid in chest

• Due to underlying cause

• Usually malignant, but what ?

• Drain for– Symptoms– Diagnosis

Pneumothorax

• What is a pneumothorax ?• How do you treat them ?• Who requires surgery ?• What does surgery entail ?

– Thoracotomy– Sternotomy– Mini thoracotomy– VATS

Lung biopsies

• Need tissue to diagnose “Interstitial lung disease”

Open lung biopsy

Chest drains

• What are they ?

• Why use them ?

• Suction and its role

• What drain do you take out MARK IT

Rocket bottle

Cardiac drain system

Post operative care

• Blood pressure

• Blood gases / saturation

• Urine output

• Bleeding

• Sputum

• Analgesia