Thoracic Surgery

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Thoracic Surgery

• By Mike Poullis

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Overview

• What is it ?
• What do you need to know as a nurse on the ward ?

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What do you need to know as a nurse on the ward ?

• Different pathologies
• Different operations
• Chest drains
• Post operative care

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Different pathologies

• Lung cancer
• Pneumothorax
• Pleural effusions
• Lung biopsies
• Trauma
• Oddities

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Different operations

• Bronchoscopy (oesophagoscopy)
• Mediasteinoscopy
• Mediasteinotomy / Chamberlains
• Thoracoscopy VATS
• Mini thoracotomy
• Full thoracotomy
• Pneumonectomy / Lobectomy / Wedge

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Anatomy

• Trachea
• 2 bronchi
• 2 Lungs
• 3 lobes on left
• 2 lobes on right

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The Right Lung
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The Left Lung
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Bronchial system
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Lung cancer

• Small cell
• Non small cell
• Squamous
• Adeno
• Large cell
• Undifferentiated

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Lung cancer

• Except for small cell carcinoma of the lung it is
  generally accepted that surgery is the most
  effective therapy for lung carcinoma

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Small Cell Lung Cancer
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Assessment of Patient

• Fitness for surgery
• Operability of the tumour - Staging

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Staging

• TNM
• T size and position of tumour
• N lymph node status
• M metastasis

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Stage IA of Lung Cancer
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Stage IB of Lung Cancer
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Stage IIA of Lung Cancer
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Stage IIB of Lung Cancer
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Stage IIIA of Lung Cancer
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Stage IIIB of Lung Cancer
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Stage IV of Lung Cancer
IV Any T, Any N, M1 Synchronous tumours in
different lobes are M1
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Fitness for Surgery

• Age
• Pulmonary function
• Cardiovascular function
• Medical conditions
• Nutritional Status
• Performance status

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Assessment of Operability

• CT scan
• Bone scan
• PET scan
• Mediastinoscopy
• Anterior Mediastinotomy
• VATS

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Bronchoscopy
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oesophagoscopy
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Mediastinoscopy
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Mediastinotomy / Chamberlains
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Mediastinotomy
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Thoracoscopy
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Video Assisted Thoracic Surgery
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Thoracotomy
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Thoracotomy - Posterolateral
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Thoracotomy - Anterolateral
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Mini thoracotomy

• Small incision thoracotomy

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Lung Resection

• Pneumonectomy
• Lobectomy
• Wedge

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Lung Resection Pneumonectomy
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Lung Resection Lobectomy (RUL)
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Lung Resection Lobectomy (RUL)
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Wedge resection
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Pleural effusions

• Fluid in chest
• Due to underlying cause
• Usually malignant, but what ?
• Drain for
• Symptoms
• Diagnosis

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Pneumothorax

• What is a pneumothorax ?
• How do you treat them ?
• Who requires surgery ?
• What does surgery entail ?
• Thoracotomy
• Sternotomy
• Mini thoracotomy
• VATS

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Lung biopsies

• Need tissue to diagnose Interstitial lung
  disease

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Open lung biopsy
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Chest drains

• What are they ?
• Why use them ?
• Suction and its role
• What drain do you take out MARK IT

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Rocket bottle
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Cardiac drain system
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Post operative care

• Blood pressure
• Blood gases / saturation
• Urine output
• Bleeding
• Sputum
• Analgesia