Pulmonary lobectomy

The right lung has three lobes and the left lung two. A lobectomy removes one of these lobes, along with its blood vessels, its bronchus and the nearby lymph nodes. It is the standard operation for localised lung cancer; it is also offered for some benign or infectious conditions that destroy a lobe. It is performed under general anaesthesia. Depending on the case, the surgeon works through several small incisions with a camera (video-assisted thoracoscopic surgery) or through an incision between two ribs (thoracotomy). The vessels and the bronchus of the lobe are divided and closed, the lobe is removed and the lymph nodes are sampled for analysis. One or two chest drains are left in place at the end. The decision is made after a full work-up: CT scan, often a PET-CT scan, bronchoscopy and lung function tests, which check that breathing will remain sufficient after the operation. In cases of cancer, the indication is discussed at a multidisciplinary team meeting. At Clinique Pasteur Tunis, lobectomy is performed in the operating theatre by thoracic surgeons, with post-operative monitoring in intensive care and then on the ward, and early chest physiotherapy.