Segmentectomy (Part of Lung)

The lungs are the main organs of the respiratory system located on either side of the heart within the chest cavity. The right lung has three lobes and the left lung has two lobes. Their function is to transport oxygen from the air into the blood and remove carbon dioxide from the blood. Segmentectomy is the surgical removal of a segment of a lung lobe.

Indications

Segmentectomy is indicated for the following:

• Early stage cancer that is confined to the tissue lining the airways without involving the nearby lung tissue
• Tumour located at the sides of the lungs
• Presence of lung nodules or lesions
• Tuberculosis (infection in the lungs)

Procedure

Segmentectomy can be performed traditionally through open surgery or advanced minimally invasive surgical technique. Both techniques are performed under general anaesthesia.

Open Surgery: During an open surgery, your surgeon makes one long incision between the ribs, below your armpit on the side of the affected lung. The ribs are separated and a portion of a rib may be removed to provide a better view and access to the lung.

Video-assisted Thoracoscopic Surgery: With technological advancements, minimally-invasive surgical techniques such as the video-assisted thoracoscopic surgery has been developed where your surgeon is able to view and access the chest cavity with 2 to 3 small incisions made on the chest region. Through one of the incisions, your surgeon inserts a thoracoscope (a thin tube attached to a video camera). The camera is connected to a television monitor to help your surgeon view the operating site. Your surgeon then inserts specially designed surgical instruments through the other incisions in order to perform segmentectomy.

Following the exposure of the diseased lung, the lung is temporarily collapsed. The entire lung or the portion of the diseased lung is removed. A flexible tube is inserted into the chest cavity (chest tube) to drain air and/or fluid postoperatively. The procedure is completed by examining the chest cavity, re-inflating the remaining lung and closing the incisions using stitches or staples.

These minimally invasive procedures are preferred when they are an option as they greatly reduce your hospital stay, pain, recovery time and risk for infection.

Risks and Complications

Like all surgical procedures, segmentectomy may be associated with certain complications such as:

• Persistent air leakage due to small injuries in the pleura
• Excessive bleeding
• Residual air space when a large portion of the lobe is removed
• Infection in the space between the linings of the lungs
• Respiratory failure in patients who have borderline lung function, requiring prolonged ventilation
• Heart attack and abnormal heart rhythms

Post-operative Care and Recovery

Following the surgery, you will spend 5 to 7 days in the hospital, or 2 to 3 days if a minimally invasive technique is performed. During this time, you will be given pain relieving medicines and will be connected to a ventilator to help you breathe. Once the ventilator is removed, you will be asked to cough in order to clear the airways, and taught breathing exercises to prevent infection and inflammation. After discharge, you are advised against driving for a week, lifting heavy weights and other strenuous activities. You are encouraged to continue your breathing exercises and start mild physical activity like walking for better blood circulation and muscle strength. You should avoid exposure to irritants like tobacco smoke, fumes and pollution, and others experiencing cold or flu symptoms.

You should call your doctor immediately in case you develop the following symptoms after a segmentectomy:

• Shortness of breath or difficulty breathing
• Increased redness, pain, drainage, or swelling around the incision site
• Yellow, green or blood-tinged sputum
• Chest pain
• Fever
• Pain in your calves which may be due to blood clots