Segmental resection of the lung. Wedge-shaped (segmental) resection of the intestine with mesentery. Technique of the operation

Pulmonectomy– removal of the entire lung.

Indications: A. malignant tumors b. some forms of tuberculosis c. bronchiectasis, etc.

Pulmonectomy technique:

1. Anterolateral or posterolateral intercostal thoracotomy.

2. We isolate the lung from intrapleural adhesions (pneumolysis) and open the mediastinal pleura.

3. Select the elements of the lung root. We treat the pulmonary vessels and bronchi in isolation, starting with the pulmonary artery. For cancerous lesions, they start from a vein (to avoid the possibility of tumor metastasis).

4. We ligate the pulmonary artery by first applying and tying the first central ligature, 2 cm below it we apply and tie the second peripheral ligature, and then between them we apply a third piercing ligature to securely close the vascular stumps. Between the second and third ligature we cross the vessel. We perform similar actions with the pulmonary vein and bronchial artery and vein.

5. We apply a clamp to the bronchus, leaving a stump of 5-7 mm and intersect the bronchus so that both lips are equal in length. We treat the bronchial stump with a bronchial constrictor or apply a series of manual U-shaped sutures.

6. Remove the lung.

7. We perform pleurization of the lung tissue with mediastinal pleura.

8. Check the tightness of the bronchial stump (a warm isotonic sodium chloride solution is poured into the pleural cavity - the absence of air bubbles indicates the tightness of the bronchial stump).

9. We drain the pleural cavity through a puncture in the chest wall at the level of the 8-9 intercostal space along the mid-axillary line.

10. We close the chest wound layer by layer.

Lobectomy– removal of a lobe of the lung.

Indications: A. chronic purulent processes (abscesses, bronchiectasis) b. tumors within one lobe c. tuberculous cavities

Lobectomy technique (using the example of the lower lobe of the right lung):

1. Anterolateral thoracotomy with intersection of the fifth and sixth ribs

2. We isolate the lung from intrapleural adhesions (pneumolysis) and open the mediastinal pleura.

3. We stupidly divide the interlobar fissure between the lower and overlying lobes and in the depth of the fissure we find the place of division of the main bronchus into lobar bronchi, as well as the arteries going to the upper and middle lobes

4. Below the origin of the middle lobe artery, we ligate and cross the terminal trunk of the pulmonary artery going to the lower lobe.

5. We cross the lobar bronchus and apply a manual or mechanical suture. The bronchial stump should be short and not devoid of serous cover.

6. Remove the lower lobe of the lung.

7. We carry out pleurization of the stump using the mediastinal pleura and suturing the upper and middle lobes of the lung to it.

8. We drain the pleural cavity and suturing the chest wound layer by layer.

Segmentectomy– removal of a segment of the lung.

Indications: A. tuberculous cavity b. echinococcal and bronchogenic cysts

Segmentectomy technique:

1. Appropriate thoracotomy depending on the location of the affected segment.

2. Pneumolysis, we examine the lung in order to identify the boundaries of the pathological process

3. We dissect the mediastinal pleura above the root of the lung and, guided by the lobar bronchus, move outward to the segmental bronchus.

4. We isolate and ligate the pulmonary artery and vein according to the general rules.

5. First of all, we cross the segmental bronchus, then the vessels.

6. By pulling the clamp placed on the bronchus and the crossed vessels, we bluntly separate the affected segment of the lung from healthy tissue. We dissect the visceral pleura and remove the affected area.

7. Careful hemostasis of the wound; on the inflated lung we achieve reliable sealing.

8. Using interrupted silk sutures, we pleurize the bed of the removed segment with sheets of mediastinal pleura.

9. Through an additional incision, we insert a drainage tube into the pleural cavity and establish active aspiration. We close the chest wound layer by layer.

Pulmonectomy– removal of the entire lung.

Indications: A. malignant tumors b. some forms of tuberculosis c. bronchiectasis, etc.

Pulmonectomy technique:

1. Anterolateral or posterolateral intercostal thoracotomy.
2. We isolate the lung from intrapleural adhesions (pneumolysis) and open the mediastinal pleura.
3. We highlight the elements of the lung root. We treat the pulmonary vessels and bronchi in isolation, starting with the pulmonary artery. For cancerous lesions, they start from a vein (to avoid the possibility of tumor metastasis).
4. We ligate the pulmonary artery by first applying and tying the first central ligature, 2 cm below it we apply and tie the second peripheral ligature, and then between them we apply a third piercing ligature to securely close the vascular stumps. Between the second and third ligature we cross the vessel. We perform similar actions with the pulmonary vein and bronchial artery and vein.
5. We apply a clamp to the bronchus, leaving a stump of 5-7 mm and intersect the bronchus so that both lips are equal in length. We treat the bronchial stump with a bronchial constrictor or apply a series of manual U-shaped sutures.
6. We remove the lung.
7. We perform pleurization of the lung tissue with the mediastinal pleura.
8. We check the tightness of the bronchial stump (a warm isotonic sodium chloride solution is poured into the pleural cavity - the absence of air bubbles indicates the tightness of the bronchial stump).
9. We drain the pleural cavity through a puncture in the chest wall at the level of the 8-9 intercostal space along the mid-axillary line.
10. We close the chest wound layer by layer.

Lobectomy– removal of a lobe of the lung.

Indications: A. chronic purulent processes (abscesses, bronchiectasis) b. tumors within one lobe c. tuberculous cavities

Lobectomy technique (using the example of the lower lobe of the right lung):

1. Anterolateral thoracotomy with division of the fifth and sixth ribs
2. We isolate the lung from intrapleural adhesions (pneumolysis) and open the mediastinal pleura.
3. We stupidly divide the interlobar fissure between the lower and overlying lobes and in the depth of the fissure we find the place of division of the main bronchus into lobar bronchi, as well as the arteries going to the upper and middle lobes
4. Below the origin of the middle lobe artery, we ligate and cross the terminal trunk of the pulmonary artery going to the lower lobe.
5. We cross the lobar bronchus and apply a manual or mechanical suture. The bronchial stump should be short and not devoid of serous cover.
6. We remove the lower lobe of the lung.
7. We carry out pleurization of the stump using the mediastinal pleura and suturing the upper and middle lobes of the lung to it.
8. We drain the pleural cavity and suture the chest wound layer by layer.

Segmentectomy– removal of a segment of the lung.

Indications: A. tuberculous cavity b. echinococcal and bronchogenic cysts

Segmentectomy technique:

1. Appropriate thoracotomy depending on the location of the affected segment.
2. Pneumolysis, we examine the lung in order to identify the boundaries of the pathological process
3. We dissect the mediastinal pleura above the root of the lung and, guided by the lobar bronchus, move outward to the segmental bronchus.
4. We isolate and ligate the pulmonary artery and vein according to the general rules.
5. First of all, we cross the segmental bronchus, then the vessels.
6. By pulling the clamp placed on the bronchus and the crossed vessels, we bluntly separate the affected segment of the lung from healthy tissue. We dissect the visceral pleura and remove the affected area.
7. Careful hemostasis of the wound, we achieve reliable sealing on the inflated lung.
8. Using interrupted silk sutures, we pleurize the bed of the removed segment with layers of mediastinal pleura.
9. Through an additional incision, we insert a drainage tube into the pleural cavity and establish active aspiration. We close the chest wound layer by layer.

Surgery at an early stage has a high success rate, meaning the patient is likely to be completely cured of the disease. The procedure is one of the main methods of treatment for non-small cell lung cancer (NSCLC), and less often for small cell lung cancer, which is due to the too rapid spread of malignant cells in the body at an early stage of tumor development.

A patient diagnosed with small cell lung cancer will most likely have to undergo chemotherapy or radiation therapy. And only if the tumor is very small, surgery will be performed. To treat cancer at an early stage, when the tumor is localized to a small area of ​​tissue, a segmentectomy can be performed - removal of part of the lung (segment) in which the malignant cells are located.

Removal of part of the lung for cancer is performed only at an early stage of tumor development. Thanks to the fast and coordinated work of “Tlv.Hospital” you will be able to receive timely treatment in one of the clinics in Israel, and thus reduce the likelihood of cancer recurrence and save most of the lung.

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The choice of surgery and treatment method depends on:

• A type of disease.
• Stages of tumor development (resection of a lung segment is performed for latent cancer, as well as at stage zero, stage I and stage II for NSCLC).
• Location of cancer.
• General lung health/function.

After a segmental resection (segmentectomy), patients usually undergo radiation therapy to completely eliminate cancer cells from the body.

Removal of part of the lung - before surgery in Israel

Before surgery, the patient must undergo a series of diagnostic procedures, including blood and urine tests, CT, PET, lymph node biopsy, etc., aimed at determining the stage of tumor development and its location in the lung.

The doctor carefully reviews the patient's medical history to assess the patient's overall health. If the patient has previously undergone any surgical operation, the doctor needs to find out about all the complications that were observed in the patient (for example, breathing problems or blood clots). It is also important to inform healthcare professionals about all types of allergic reactions, especially to anesthetics.

The patient should tell doctors about the medications and dietary supplements he is taking, otherwise, by continuing without permission from a specialist, he risks prolonging the effect of anesthesia, causing bleeding, or raising blood pressure during the surgical procedure. A few weeks before surgery to remove part of the lung (in most cases), the patient is advised to stop taking:

• Blood thinning medications (warfarin and clopidogrel).
• Vitamin E.
• Herbal preparations containing ginseng, omega-3 fatty acids, valerian and ginkgo.

Removing part of the lung - procedure for performing the operation

Segmental resection in Israel can be performed in 2 ways: open method and VATS method.

Gentle approach

VATS method (video-assisted thoracoscopic surgery) - removal of the pulmonary segment is performed through 2-4 small incisions made in the chest area. Typically, one cut is about 2.5 inches long, while the rest are approximately 0.5 inches. Next, a special tube equipped with a small video camera is inserted into the incision and transmits an enlarged image to a computer monitor located in the operating room. To perform resection of part of the lung, the doctor uses long surgical instruments, which are also inserted through the incisions.

During surgery using this method, unlike the open method, the doctor does not have to spread the ribs and make a large incision. A segment of the lung is removed through the distance between the ribs.

Videothoracoscopic surgery is performed under general anesthesia. After the procedure is completed, the surgeon inserts special drainage tubes into the chest cavity and closes the incision. The tubes are removed some time after part of the lung is removed. Most patients undergoing minimally invasive surgery remain in the clinic for 1 day.

Open segmental resection

Through an anterolateral incision of the chest (thoracotomy), the doctor removes the apical or anterior pulmonary segment, and through a posterolateral incision, resection of the posterior segments of the lung is performed.

The patient is under general anesthesia, his position is fixed with special belts on the operating table. During the operation, all vital signs are monitored using a temperature sensor and pulse oximeter. The installed IV ensures the administration of necessary fluids and medications during and after surgery. An endotracheal tube inserted through the mouth into the trachea to protect the airway, a nasogastric tube to drain excess fluid from the stomach, and a urinary catheter to monitor kidney function may also be used.

During surgery, the doctor performs a resection of the affected segment of the lung, performs drainage using two special tubes and sutures the incision.

The period after removal of part of the lung

For the first time after the operation, the patient is under constant monitoring by medical workers at the Israeli clinic. He continues to experience pain for several weeks, but the pain level is controlled with analgesic medications both while in the hospital and upon returning home. For a number of days after lung resection, the drainage is not removed, but is used to facilitate the process of filling the lungs with air and draining excess blood and fluids from the operating field.

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A segmentectomy is a surgical procedure to remove part of an organ or gland. The procedure has several variations and can be called segmental resection, partial excision, wedge resection, etc.

Lung segmentectomy is usually performed to treat a malignant tumor and involves removing a part or segment of the organ in which the cancer is located.

Lung cancer is the second most common type of cancer among men and women, and the leading cause of death in both sexes. The number of deaths due to lung cancer is higher than that of breast, prostate, pancreatic and colon cancers combined.

Research has shown that almost 90% of lung cancer cases are caused by smoking. Other most common causes of the disease include: passive smoking, exposure to asbestos and other harmful chemical compounds.

Reasons for lung segmentectomy

When a malignant tumor is localized in a certain segment of the lung, removal of this part of the organ allows one to achieve good treatment results. In some cases, regional lymph nodes are additionally removed. Options for surgical intervention depend on the stage of lung cancer, the presence of metastases in other organs, the size of the tumor and type of cancer, as well as the general condition of the patient.

Segmental resection is considered by doctors for non-small cell lung cancer (NSCLC) as a treatment option for tumors at the latent stage of pathology development, as well as at the first and second stages. At the zero stage, this method of treatment shows very high efficiency - this is due to the fact that the tumor tissue has not yet spread to neighboring lung tissues and a segment of the lung can be removed without difficulty. However, additional treatment with radiotherapy or chemotherapy is usually not required.

Segmentectomy is also performed at the first stage of the disease in cases where extensive surgery to remove part or lobe of the lung (lobectomy) is impossible. If the patient has insufficient pulmonary function to undergo major surgery, a segmentectomy is also performed. Additional chemotherapy after surgery is usually not prescribed. If a person has serious medical contraindications to this operation, the main treatment, as a rule, is radiation therapy.

In stage 2 NSCLC, the tumor can be removed by segmentectomy or lobectomy. Wedge resection is usually performed if lobectomy is not possible. In some cases, a pneumonectomy (removal of the entire lung) is performed. After surgery, radiation therapy is usually used to destroy pathogenic cells remaining after surgery.

The effectiveness of using segmentectomy to treat small cell lung cancer (SCLC) is being studied by scientists.

Because of the need for radiotherapy after segmentectomy, some patients, such as pregnant women and people with syndromes incompatible with radiotherapy, may not be candidates for segmental resection.

Preparation for segmental lung resection

The doctor informs the patient about the specifics of preoperative preparation. As a rule, the basic rule of such preparation is the refusal to eat and drink from the evening of the upcoming day of surgery.

After resection

After segmental resection, the patient's physical activity is limited for several days. If necessary, painkillers are prescribed. The length of hospital stay depends on the size of the removed part of the organ and other factors.

Radiation therapy is usually given for four to six weeks after surgery, but the length of treatment may vary.

Alternative treatment for lung cancer

Other treatments for lung cancer include:

• Chemotherapy,
• Radiation therapy
• Laser therapy,
• Photodynamic therapy, etc.

Risks of segmental resection

Risks of the procedure, like other surgical procedures, include infection and bleeding, pneumonia and breathing problems.

Factors influencing the prognosis of pulmonary segmentectomy include the following:

• Stage of cancer and presence of metastases,
• Tumor size
• Type of lung cancer
• Dyspnea,
• General health of the patient.

Unfortunately, modern treatment methods do not always completely defeat the disease. If cancer recurs after treatment, cancerous growths may appear in the brain, chest, spine, and other parts of the body.

According to the latest scientific research, based on a detailed bronchographic study of patients, it was established that bronchiectasis is a primarily segmental disease, i.e., it is initially localized in one segment and only over time, progressing, moves to the entire lobe, then captures individual segments of the other lobe, and finally affects everything is easy.

Recognition of early forms diseases, made possible by the development of segmental bronchography technology, raised the question of the need for surgeons to resect in such cases not the entire lobe, but only a certain segment.

Bronchectasias have property primarily affect the bronchopulmonary segments of a certain area. Bronchiectasis most often occurs in the basal segments of the lower lobe. Simultaneously with the basal segments, the lingula of the left upper lobe and the middle right lobe are often involved in the process. According to some data, the right middle lobe is affected by bronchiectasis together with the right basal segments in 45% of cases, and the lingula simultaneously with the lower left lobe - from 60 to 80% of cases.

In connection with this there was developed question about segmental resection. Along with the removal of the affected left lower lobe, the affected lingula was also removed, leaving the upper part of the upper lobe in place and preserving it for breathing.

Meanwhile in the upper segment or zone of the lower lobe abscesses are most often localized, but at the same time they are less often affected by bronchiectasias. All this puts before us the task of more detailed development of a segmental resection technique so that only the affected segment can be removed and all healthy, viable segments of the lung can be left in place.

Emergence Problems about segmental resection, as well as its resolution, became possible after the work of B.E. Linberg, who proposed segmental division of the lung. B. E. Linberg points out that the bronchopulmonary segment can be removed without technical difficulties and without the risk of damaging adjacent segments.

Segmental resection, removing all affected segments, preserves healthy sections and protects them from subsequent involvement in the disease process due to proximity to diseased segments. Thus, this resection allows for two basic principles of surgery: 1) to cure the patient, 2) to preserve as much functioning tissue as possible.
Over the past years published a number of reports of complete cure of patients using segmental resection.

We used segmental resection in 12 cases.
Patient V., 29 years old, who suffered from multiple abscesses and bronchiectasis of the lower left lobe, we simultaneously removed the lower left lobe and the lingula of the upper left lobe. The postoperative course went smoothly. A month after the operation, the patient was discharged from the clinic in good condition.

Patient K., 21 years old, we performed a left lower lobe lobectomy for the lower left lobe on 30/1X 1999. After the operation, he was left with a slight cough with sputum. The patient was discharged from the clinic a month after the operation, and 3 months later he returned again. Segmental bronchography revealed bronchiectasis in the lingula of the upper left lobe. On January 24, 2000, he underwent segmental resection - removal of the affected lingula.
In both cases, we followed the exact methodology described below.

Significance of segmental resection is especially high because bronchiectasis in almost 30% of cases is a bilateral disease. Consequently, without segmental resection, if both lower lobes are affected with a transition to the lingula on the left and the middle lobe on the right, the disease becomes inoperable. Segmental resection can achieve a permanent cure by removing the affected and preserving healthy segments on both sides. With bilateral lesions, simultaneous involvement of the right middle and lingula of the left lobe is sometimes noted along with bilateral lesions of the basal segments of the lower lobe.