What you need to know about:

Lobectomy

Fast Fact

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Average Cost:

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Recovery Period:

4 weeks or more

Permanence:

Depends on patient condition

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Doctors

Time it takes:

2-6 hours

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Anesthetize:

General Anesthesia

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Overview of

Lobectomy

in Thailand

A lobectomy is a surgical procedure to remove a section of the lungs, called a lobe. The right lung has three lobes—upper lobe, middle lobe, and lower lobe. The left lung has two lobes—the upper lobe and lower lobe. In the case of lung cancer, the affected lobe may have to be removed as well as its surrounding lymph nodes in the chest so they can be examined in the laboratory for the presence of cancer cells.

A lobectomy is also a common procedure performed to treat lung cancer, especially in its early stages in order to prevent the disease from spreading to other parts of the body. This is also the preferred procedure for masses in the lungs, tuberculosis, lung abscess, emphysema, and fungal infection in the lungs.

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Goals of

Lobectomy

A lobectomy may be done when a problem is found in 1 lobe, which can be for both diagnostic and therapeutic purposes. A lobe may be removed so that disease isn'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 does not 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), one 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.

Price of

Lobectomy

Average Cost

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Price Range

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Pros and cons of

Lobectomy

Pros

-A lobectomy can stop or slow the spread of cancer, infections, and diseases.

-The surgery may also allow your doctor to remove a portion of the lung which affects the function of other organs. For example, a benign tumor may not be cancerous but may press against blood vessels, preventing adequate blood flow to other parts of the body. By removing the lobe with the tumor, your surgeon can effectively solve the problem.

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Cons

-As with all surgical procedures, this procedure comes with risks such as bleeding and infections

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How it works:

Lobectomy

There are several ways in which lobectomies can be performed:

1. Open Lobectomy

As its name suggests, this traditional procedure involves a long incision that will be made across the side of the chest. An intravenous line will be administered to deliver fluids and medications. The anesthesiologist will talk to you about the general anesthesia that will be used during the procedure and how you should behave after. Lobectomy is an open surgery with an incision made in the side of the body, measuring approximately 20 centimeters. When the ribs can be seen, a special tool will be used to spread them apart. The surgeon will clamp arteries, veins, and bronchi before removing the affected lobe. One or more drains will be placed in the chest cavity to drain fluids before the incision is closed. The cut will be closed with stitches (sutures) or staples. A bandage or dressing will be put on the area. The procedure usually lasts between 2-4 hours.

2. Video Assisted Thoracoscopy (VATS) lobectomy

This procedure involves making 3 to 4 small incisions on the side of your chest. A lobe of the lung is removed through the small incisions in the chest with the assistance of instruments and a camera. This procedure is becoming the preferred technique for many lung surgeons due to its minimally invasive approach. A VATS lobectomy may be considered for stage 1 or stage 2 non-small cell lung cancer (NSCLC). When a VATS lobectomy is possible, the procedure will allow patients to recover faster with fever complications compared to the open lobectomy.

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Preparation before

Lobectomy

Pre - treatment

It is important that your health and disease are assessed before the procedure. You will be given all the information about your disease and the treatments offered for the most effective treatment planning. Your surgeon will explain your condition, the reason for surgery, all the risks involved, and the benefits of surgery. Furthermore, you will have to do the following:

1. Before the procedure you will undergo a physical examination and laboratory tests, such as lung function test, and the doctor may recommend that you undergo physical therapy and practice coughing and breathing.

2. If you have a history of excessive bleeding or abnormal bleeding, or if you or a family member have bruises all over the body, please let your doctor know.

3. Please inform the medical team about any allergies you have to medications, food, and chemicals/substances. Also, let them know if you have any implanted electrical devices.

4. You will need to stop certain medications for 5-7 days before the procedure, such as blood thinners. Please let your doctor know about all medication and supplements you are taking.

5. You will be asked to fast for at least 8 hours before the procedure or as recommended by the doctor.

6. Avoid drinking and smoking cigarettes for at least 1 week before the procedure.

7. The area that will be operated on will be shaved and cleaned before the procedure.

8. You will be given consent forms to sign before the procedure. Please make sure you read all documents before signing them.

9. On the day of the procedure, please bring all your current medication to the hospital.

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Recovery after

Lobectomy

Post - treatment

After surgery, you will be monitored at the Intensive Care Unit (ICU) where you can be closely monitored. If the breathing tube given to you during surgery remains in place, you will not be able to talk. You will likely have drains coming out of your chest to remove air, blood, and other fluids from the chest cavity. Your doctor will remove these when appropriate. Intravenous (IV) lines give you fluid and medications. Monitors record your heartbeat and the amount of oxygen in your blood. You may spend 1-2 days or more in an Intensive Care Unit (ICU) until your symptoms are stable. After that, you will be transferred to a regular hospital room.

You will experience pain for 2-3 days after the procedure, after which pain should improve gradually. You will be given pain medication to manage your discomfort. Practice breathing and move your body while you are in the bed. Get out of bed as soon as you can and walk to strengthen your lungs. How long you stay in hospital will depend on your condition, but most patients are in hospital for at least 1 week.

Please let your doctor know immediately if you experience any of the following after the procedure:

-Difficulty breathing, abnormal fatigue, pain when breathing

-Fever higher than 38 degrees Celsius

-Severe redness or swelling of the incision

-Bleeding or seeping of fluid from the incision

-Acute and severe chest pain

-Coughing or worsening cough, coughing blood, or coughing up green or yellow sputum

-Confusion or altered consciousness

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Risks & side effects

The severity of complications will depend on the patient’s health, but possible complications include:

-Excessive bleeding

-Infection

-Collapsed lung

-Injury to the bronchi or tissues of the lungs, causing air or fluid to fill up the chest cavity or the pleural space

FAQs:

Lobectomy

What are the recommendations for home care?

Answer:

You will need to recover at home for 2-4 weeks. If you have any questions, please talk to your doctor or medical team.

· Activity. Avoid activities that involve pulling or pushing, lifting heavy objects, and other strenuous activity. Avoid driving for 2-4 weeks as this can affect the incision. Avoid sexual intercourse until the incision is healed or until you can go up and down two flights of stairs without difficulty breathing or becoming too tired.

· Wound Care. When your doctor clears you to bathe, shower daily with soap. Dry the surgical wound well and keep it clean. Don’t apply any creams, lotions, or powders to the incision until it is fully healed and appears like normal skin. Please contact your doctor if the wound is inflamed or swollen, if the pain is worsening, or if the wound is leaking fluid or blood.

· Diet. Your diet should be restricted in accordance to existing medical conditions. Eat healthily to promote wound healing.

· Medication. If you are prescribed antibiotics, please take them until you finish them. Please take all medication as prescribed by your doctor.

· Exercise. Practice breathing continuously. Walk at least once or twice a day. Avoid strenuous exercise for at least 2-4 weeks. Please follow the doctor’s recommendations.

· Appointments. Please keep all follow-up appointments so your wound can be monitored and stitches removed. If you experience any abnormal symptoms, such as fever, difficulty breathing, worsening fatigue, worsening cough, coughing up abnormal sputum, etc., please see your doctor before the scheduled appointment.

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What are the recommendations for travel?

Answer:

You should plan to stay in Thailand for at least 2-3 weeks through the duration of your treatment.

It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment.

When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis.

Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.

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What is the pain like after surgery?

Answer:

Many patients are concerned about the amount of pain they anticipate after the operation. However, many steps are taken to minimize post-operative discomfort. Often, an epidural catheter is used for pain control. This is a catheter placed into the small of the back through which pain medication is infused. An epidural catheter provides excellent pain relief for the first few days after the operation. Once the catheter is removed, pain pills are prescribed to limit the discomfort. Patients are likely to continue pain medication every day for four to six weeks following surgery.

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How Long Is The Recovery Period? Will Help Be Needed At Home?

Answer:

When patients are discharged from the hospital following lung surgery they are able to walk on their own and breathe without difficulty. The incision is usually closed with dissolvable sutures. These sutures do not need to be removed and allow one to shower soon after the operation. Patients are advised not to drive until they no longer require pain medication every day. Although some help around the house for the first week or two may be necessary, there is no need for nursing care at home. It is recommended that patients plan to recover for four to six weeks at home after lung surgery, although some patients may return to work sooner.

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