Removal of the lung ( pneumonectomy )
Pulmonology / / August 12, 2017
Operations on chest wall and chest cavity
(method of operation)
position of the patient depends on the surgeon access.
2. Revision of the pleural cavity and the lung allocation of adhesions. opening the pleural cavity, the surgeon carefully conducts visual and palpation of its audit.Then it starts to produce light of adhesions.Depending on the number and density of pleural adhesions their separation produce a cotton swab or cotton swab using a long and scissors.
3. Select elements of lung root. Special pliers for easy gripping is removed the upper lobe posteriorly to allow access to the root.Select elements of the root is easy to produce, as a rule, scissors and cotton swab.To do this, the surgeon prepares sister small tight balls clamped in the clamp or forceps Mikulic.Such cotton swab should be prepared a few, they should be changed frequently.Once the ball soaked in blood, he starts to slide and worse separates tissue.While the surgeon selects elements from the surroun
Once selected one vessel, the surgeon brings under his dissector, a sister delivers strong silk ligature №5 6 or 50 cm long, the end of which is clamped to the tip of the long type clamp Billroth.After ligature under a bushel, its slightly tensioned and fed the same second ligature.Now fasten the proximal ligature.For biasing it as close as possible to the pericardium have to file a fork deflating ligatures (Vinogradov stick).After tying both ligatures submit surgeon needle holder with a needle and silk thread №3, he will sew the vessel closer to the proximal ligature.Similarly treated and other vessels.
4. Processing of the bronchus. submitting surgeon small cotton swab to extract the bronchus, sister prepares for work aids UO-40 and (or) RO-60.After sewing machine bronchus is necessary to submit to the surgeon's scalpel sharp bryushisty to cross it.Before crossing to the distal main bronchus impose powerful clip bronchus (if it is not, you can use Fedorov clamp renal pedicle).This prevents the ingress of bronchial secretions in the pleural cavity and its infection.Surgeon crosses the main bronchus between the unit and clamp.After removing from the pleural cavity light without removing the device from the bronchus, bronchial stump smeared with tincture of iodine.Now you have to submit to the surgeon the other clip of the bronchus, followed by the assistant takes care unit.The second clip of the bronchus to be supplied to the surgeon to remove the stapler in the event that any chance for any reason it does not work and will not bronchus sewn.Convinced of the sealing seams on the bronchial stump, sewn mediastinal pleura over the bronchial stump continuous suture (silk number 4 or chromic catgut).
5. Washing of the pleural cavity. For washing the pleural cavity and check seam tightness in the bronchial stump should be prepared in advance 1.5 liters of warm isotonic sodium chloride solution or a better antiseptic solution.At the request of the surgeon's sister takes just 500 ml of this solution, which he pours into the pleural cavity.If the bronchial stump of air bubbles are not allocated, then the seam is sealed.The solution was removed by electric pumps.Lavage is repeated 2-3 times, which helps to remove residual blood and disinfects the pleural cavity.
6. thoracostomy after pneumonectomy is not usually done, if at the time of surgery was not her apparent infection with pus.In this case, the drain is set as a rule, in the eighth and ninth intercostal space on the posterior axillary line.
7. stitching thoracotomy wound.