Pulmonary resection involves the surgical removal of part or all of the lung under general anesthesia and includes various techniques such as lobectomy and pneumonectomy. Indications for this procedure range from congenital conditions and trauma to neoplastic diseases, and it may be approached through methods like thoracotomy or video-assisted thoracic surgery. Complications can occur both early and late, including respiratory failure and chronic pain.

1. Pulmonary
resection
HUSSEIN ELKHAYAT , MD
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Assiut university
Faculty of medicine
Cardiothoracic surgery dept.

2. Definition
 operations done under general anaesthesia in
which part or whole of the lung is removed.

3. Surgical anatomy of the lung

4. Segmental anatomy of the lung

5. Types of pulmonary resection
 Blebectomy
 Wedge resection
 Segmentectomy
 Lobectomy
 Bi lobectomy
 Pneumonectomy
 Extended pulmonary resection
- sleeve resection
- carinal resection

6. Subpleural blebs /blebectomy

7. Wedge resection

8. Segmentectomy

9. Lobectomy

10. Pneumonectomy

11. Indications of pulmonary
resection
Congenital:
congenital lobar emphysema
congenital adenomatoid cyctic malformation of a lobe.
Traumatic:
severely lacerated lobe.
Inflammatory:
Bronchectasis
chronic non resolving lung abscess
TB cavity
destroyed lobe or lung.
Neoplastic:
resectable lung cancer
pulmonary metastatectomy
Lung volume reduction surgery:
in ttt of emphysema.
In preparation for lung transplantation: in end stage lung diseases.

12. Congenital cystic adenomatoid malformationCongenital lobar emphysema

13. Approaches for pulmonary
resection
 Thoracotomy:
 postero-lateral thoracotomy in lateral decubitus position,
 anterior thoracotomy in supine position,
 Axillary thoracotomy
 posterior peri-scapular thoracotomy in prone position,
 bilateral anterior thoracotomy with or without transverse sternotomy
in bilateral lung transplantation.
 Median sternotomy and parasternal approaches: very
rare.
 Video-assisted thoracic surgery (VATS) (thoracoscopy):

14. Postrolateral thoracotomy

15. Axillary thoracotomy

16. VATS

19. Lung transplant

20. Complications of pulmonary
resection
 Early (30 days complications):
 Acute postoperative respiratory failure, due to
 Pain (postoperative analgesia; local + general, is mandatory).
 Atelectasis & Pneumonia (chest physiotherapy, IV antibiotics, ?
bronchoscopy).
 Pulmonary oedema (restriction of IV fluids, diuretics, chest
physiotherapy).
 ARDS .
 Cardiac arrhythmia (AF in patients > 60 ys).
 Bleeding.
 DVT, pulmonary embolism,
 Infections: empyema, wound infection and dehiscence.
 persistent air leak (visceral, disruption of bronchial stump causing
bronchopleural fistula),

21. Complications of pulmonary
resection
Late:
 chronic pain,
 chronic respiratory failure,
 post-pneumonectomy syndrome

22. THANK YOU
 Dr_khayat@Hotmail.com
 See this video on youtube for more operative details about VATS
https://youtu.be/aegWclsbJvk