Lobectomy

What is a lobectomy?

A lobectomy is a surgery to remove one of the lobes of the lungs. The lungs have sections called lobes. The right lung has 3 lobes. The left lung has 2 lobes. A lobectomy may be done when a problem is found in just part of a lung. The affected lobe is removed, and the remaining healthy lung tissue can work as normal.

A lobectomy is most often done during a surgery called a thoracotomy.

In most cases, during a lobectomy, the surgeon makes the cut (incision) at the level of the affected lobe. The cut is most often made on the front of the chest under the nipple and wraps around the back under the shoulder blade. The surgeon gets access to the chest cavity through the exposed ribs to remove the lobe.

In some cases, a video-assisted thoracoscopic surgery (VATS) is used to do a lobectomy. This is a less-invasive procedure. With this type of surgery, the surgeon makes 3 or 4 small cuts instead of 1 large cut. Tiny tools are put into the chest cavity. One of the tools is called a thoracoscope. It’s a tube with a light and a tiny camera that sends images to a computer screen. This shows the internal organs on the screen. The surgeon uses the small tools through the other cuts to do the surgery.

Why might I need a lobectomy?

Your healthcare provider may advise a lobectomy when a problem is found in 1 lobe. During the surgery, the lobe may be removed so that disease doesn't spread to the other lobes. This may be the case with tuberculosis or certain types of lung cancer.

Chest and lung health conditions that may be treated with lobectomy include:

• Tuberculosis (TB). This is an ongoing (chronic) bacterial infection that often infects the lungs.

• Lung abscess. This is an area of pus that may form in the lung. If the abscess doesn't go away with antibiotic medicine, it may need to be removed.

• Emphysema. This is a chronic illness caused by the breakdown of the elastic fibers in the lungs. This makes it harder for the lungs to move when you breathe.

• Benign tumor. This is a growth that is not cancer. It can press on large blood vessels and affect the function of other organs.

• Lung cancer. This is a type of cancer that may affect the main airways to the lungs (the bronchi), 1 or more lobes of the lungs, the pleural lining, or other lung tissue. If not treated, it can spread to other parts of the body.

• Fungal infection. Fungi can grow in the body and cause infections in the lungs.

Your healthcare provider may have other reasons to advise a lobectomy.

What are the risks of a lobectomy?

All procedures have some risks. The risks of this procedure may include:

• Infection

• Air in the space between the lung covering (pleural space) that causes the lung to collapse (pneumothorax)

• Bleeding

• A tube-like opening between the airway (bronchus) and pleural space that causes air or fluid to leak into the chest (bronchopleural fistula)

• An area of pus in the chest cavity (empyema)

• Fluid in the space between the lung and inner chest wall (pleural effusion)

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with them about any concerns you have.

How do I get ready for a lobectomy?

Your healthcare provider will explain the procedure to you. Ask any questions you have. Think about bringing a family member or friend to take notes and make sure all your questions are answered. You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully. Before you sign, ask questions if anything is not clear.

Tell your healthcare provider if you:

• Are pregnant or think you could be

• Are allergic to contrast dye or iodine

• Are sensitive to or allergic to any medicines, latex, tape, or anesthetic medicines (local and general)

• Take any medicines, including prescription or over-the-counter medicines, vitamins, herbs, and supplements

• Have had a bleeding disorder

• Have had any recent illnesses

• Take blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting

Also:

• Stop taking certain medicines before the procedure, if instructed by your healthcare provider.

• Follow any directions you are given for not eating or drinking before the procedure.

• Stop smoking.

• Plan to have someone drive you home from the hospital.

• Follow any other instructions your healthcare provider gives you.

Your healthcare provider may perform blood tests, breathing tests, or other tests or exams before the procedure. They will tell you more.

What happens during a lobectomy?

The procedure almost always needs an inpatient stay. This means that it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, the procedure will follow this process:

1. Your healthcare provider will ask you to remove your clothes. They will give you a hospital gown to wear. They may ask you to remove jewelry or other objects.

2. You will lie down on an operating table.

3. Your provider will put an IV (intravenous) line into your arm or hand.

4. Your provider may give you antibiotics before and after the procedure.

5. Your provider will give you general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure.

6. Your provider will put a breathing tube into your throat and hook you up to a breathing machine (ventilator). They will watch your heart rate, blood pressure, and breathing during the procedure.

7. Your provider may put a soft, flexible tube (catheter) into your bladder. This is to drain urine during the procedure.

8. Your provider may trim hair in the area of surgery. They will clean the skin in the area with an antiseptic solution.

9. The surgeon will make a cut (incision) on the front of your chest at the level of the lobe to be removed. The cut will go under your arm around to your back.

10. When the ribs can be seen, the surgeon will use a special tool to spread them apart. They will remove the lung lobe.

11. The surgeon may put 1 or more tubes into your chest. These are to help remove air and fluid after surgery.

12. The surgeon will close the cut with stitches (sutures) or staples. They will put a bandage or dressing on the area.

13. Your provider may put a thin tube (epidural catheter) in the area of the lower spine. This is done to send pain medicine into your back. It may be done in the operating room or in the recovery room.

What happens after a lobectomy?

After the procedure, you will spend some time in a recovery room. You may be sleepy and confused when you wake up from general anesthesia or sedation. Your healthcare team will watch your vital signs, such as your heart rate and breathing. They'll give you pain medicine if you need it. A chest X-ray may be done right after the surgery. This is to make sure your lungs are OK. You will stay in the hospital for several days.

You will likely have 1 or more chest tubes near the cut (incision) to drain air or fluid from the chest. The chest tubes may cause pain when you move, cough, or breathe deeply. Your healthcare provider will take them out before you leave the hospital.

Your healthcare team will teach you deep-breathing exercises and coughing methods to help your lungs re-expand after surgery. This is to help breathing and prevent pneumonia. You may need oxygen for a period of time after surgery. In most cases, the oxygen will be stopped before you go home. Or you may need to go home with oxygen.

Your healthcare team will tell you to move around as much as you can while in bed, and get out of bed and walk as soon as you can. This will help your lungs heal faster.

Your healthcare team may give you fluids to drink a few hours after surgery. They will give you food to eat as you are able.

Before you leave the hospital, you’ll make an appointment for a follow-up visit with your healthcare provider. You will go home when your healthcare provider says it’s OK. Someone will need to drive you home.

At home, keep the cut clean and dry. Your healthcare provider will give you bathing and wound care instructions. The stitches or staples will be removed during a follow-up appointment. The cut may be sore for a few days. Your chest and shoulder muscles may ache, especially with deep breathing, coughing, and activity. You can take pain medicine as advised by your healthcare provider. Aspirin and some other pain medicines may increase bleeding. Make sure to take only the medicines your healthcare provider advises.

Keep doing the breathing exercises you learned in the hospital. Slowly increase your physical activity as you can handle it. It may take a few weeks to return to normal. You may need to not lift any heavy items for a few months. This is to prevent strain on your chest muscles and the cut.

While you’re healing, take steps to prevent exposure to:

• Respiratory infections, such as colds, COVID-19, and flu

• Tobacco smoke

• Chemical fumes

• Environmental pollution

Call your healthcare provider if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider

• Redness or swelling of the incision

• Blood or other fluid leaking from the incision

• Pain around the incision that gets worse

• Feeling short of breath

• Trouble breathing

• Pain with breathing

• Chest pain

• Cough

• Confusion or other change in mental state

• Green, yellow, or blood-tinted sputum (phlegm)

Your healthcare provider may give you other instructions after the procedure.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure