This handout was created for our patients and their families to better understand the various procedures involving the chest and lungs. We hope this information is interesting, answers your questions, and helps you to understand the importance that YOU play in maintaining your health.

4230 Harding Road, Suite 530 | Nashville, TN 37205 | p: 615.222.1270 | www.tnthoracic.com

Chest and Lung Surgery

Operation Procedures

Bronchoscopy:This procedure allows the surgeon to visualize the main airways inside the lungs for examination or to take tissue samples (biopsies). The surgeon uses a small videoscope—bronchoscope—which may go through your mouth or nose. It may be done before your surgery day, but it is usually performed again just prior to surgery in the operating room.

Mediastinoscopy:The mediastinum is the area located between the two lungs. It contains the following structures: •Heart •Thymus(immunesystemgland) •Esophagus •Trachea •Largebloodvessels •NumerouslymphnodesA small neck incision is made and another small videoscope—mediastinoscope—is inserted to see thestructuresintheupperportionofthechest.Lymphnodebiopsiesaretakentohelpinthestag-ing of certain diseases. This may be performed before your surgery as an outpatient procedure.

Video-AssistedThoracicSurgery(VATS):VATS,alsocalledminimally-invasivethoracicsurgery,isperformedwithasmallvideoscope—tho-racoscope—using small incisions and specialized instruments. This type of procedure typically has less pain and quicker recovery times than traditional thoracotomy. If you need thoracic surgery, a minimally-invasivemethodisconsideredfirst.However,someproceduresarestillbestperformedusing a traditional “open” technique. Your surgeon will carefully determine which surgical ap-proach is best to treat your specific condition.

Thoracotomy:This procedure allows the surgeon to access the inside of your chest. An incision is made along the side of your chest, and the ribs are spread apart to better visualize your lungs. The amount of lung tissue removed will depend on the type, size, and specific location of the abnormal area(s).

Operation Procedures

 

Wedge Resection:During this procedure, only a small part of the lung is removed. This is usually performed if the abnormal area is benign or small and is located on the edge of the lung.

Lobectomy:The lungs consist of multiple lobes—3 lobes on the right and 2 lobes on the left. In this procedure, an entire lobe of the lung is removed.

Pneumonectomy:This procedure involves removing an entire lung. It is commonly performed if there is concern that the can-cer has spread throughout the lung or the abnormal area is centrally located.

 

Planning for your Surgery

Date&TimeofSurgery:Your surgeon or his staff will inform you of the date and approximate time of your operation. Should you have any questions, please do not hesitate to call us at 615-222-1270.

Pre-SurgeryTesting:Before surgery, you will need to have pre-admission testing done on the 2nd Floor of the Medical Plaza. Most of your bloodwork will be done there. You will also need pulmonary function tests (PFTs)toassessyouroverallbreathingtomakesureyouwillbeabletotolerateathoracic/lungoperation.

Patients over 40 years old or who have a family history of heart disease may need an

electrocardiogram(ECG),whichrecordstheelectricalpatternsofyourheart.Ifthereareany concerns or abnormalities, your surgeon may ask that you see a cardiologist prior to your operation.You may also speak with the anesthesiology team to discuss your medical history. They will discuss medications used to help you relax before the surgery and to put you to sleep.

You are strongly encouraged to stop smoking at least 2 weeks before the operation, preferably 4 weeks.Patientswhocontinuetosmokemayhavecomplications/problemssuchaspneumoniafollowing the operation. Smoking cessation programs are available through Saint Thomas Pulmonary Services (615-222-6742). You may also contact your primary doctor or family doctor who can also offer help to quit smoking such as nicotine patches, gums and inhalers.

Pre- Operative Teaching and Exercises

Prior to your surgery, being in good physical health and condition is important for helping you recover easier and faster. The following exercises will help you build up and strengthen your breathing muscles.

Walking is excellent exercise once you return home. It is important, not only for cardiovascular health, but also to improve breathing ability and improves overall blood circulation. Stair climbing is another way to help improve breathing.

ArmExercises:(thiscanbedonesittingorstanding) •Liftyourarmstoshoulderlevel,straightoutinfrontofyou,paralleltothefloor •Asyoubreathein,raiseyourarmsaboveyourhead,putyourhandstogetherand

hold for 2 seconds •Breatheout,loweringyourarmsslowlyandexhalethroughpuckeredlipsandstopwhen

yourarmsareparalleltotheflooragain •Repeat10times

LegExercises:(thisisdonewhilesitting) •Liftonelegupoffthechairwhiletighteningthemusclesonthefrontofyourthigh;

straighten your leg outward and hold for 3 seconds •Bendyourkneeandloweryourlegslowly •Repeat10timeswitheachleg ShoulderExercises:(doneaftersurgeryduetoshoulderstiffness)1. With both hands held together, lift your arms straight over your head and then lower to the

starting position. Repeat 5 times.2. With both hands held together, lift your arms over your head and touch the back of your

neck.Loweryourhandstothestartingpositionandrepeat5times.

The Day Before Surgery

When packing for your hospital stay, please bring the following items with you: •Incentivespirometer(akabreathingbuddy) •Listofyourcurrentmedications(ormedicationsintheiroriginalbottles) •Basictoiletriessuchasacomb/brush,toothbrush,toothpaste •Slippers,pajamas,robeifyouwish

Please do not bring any valuables such as credit cards, money, or jewelry. If you do bring valuables, please have your nurse contact hospital security so they can be safely secured during your stay.

Things to Remember: •Donoteatordrinkanythingaftermidnight! •Youcanbrushyourteethandusemouthwash,butpleasebesuretonotswallowanything •Youmaynotbeabletowashyourhairfollowingyouroperation,soyoumaywanttowashit

the night before your surgery •Bathe/showerthenightbeforeandthemorningofyoursurgery

o Use an antibacterial soap paying special attention to your chest, neck, underarms and back

•Afteryourshower,donotputanythingonyourskinincludinglotions,creams,powders,deodorants, etc.

The Morning of your Surgery

Preparations: •Youwillreceiveahospitalgown—thisistheonlythingyoumaywearintheoperating

room •Youwillnotbeallowedtowearanything

o Please remove any contact lenses, eyeglasses, dentures, partial plates, jewelry, bobby pins, wigs, etc.

•Youmayusethebathroomtoemptyyourbladder •Followingthis,youwillbemovedtotheholdingarea.Yourfamilyisnotallowedinthis

area, but they may go to the Family Waiting Room on the 1st Floor.

HoldingArea: •Here,themedicalstaffwillstartmonitoringyouandmakesureyouarecomfortable

o A nurse will verify specific information about you and double check drug allergies o You will get an automatic blood pressure cuff on your arm o An intravenous (IV) line will be started for medications o The anesthesiologist will meet with you again o You may get an epidural catheter for pain control

Operating Room: •Thestaffandnurseswillhelpyoufromthestretchertotheoperatingtable o They will be wearing uniforms, masks, gloves and surgical caps o You can ask for blankets if you are cold •Smallstickypadswillbeappliedtoyourchesttomonitoryourheart •YouwillgetIVmedicationstohelpyourelaxandsleep •AFTERyouareasleep,atubewillbeplacedinyourwindpipetohelpyoubreathe;abladder

catheter will also be put in

After you Operation

Recovery Room:You will wake up in the recovery room—family is not allowed in this room, but they will be notified that your operation is complete. While awaking from anesthesia, you may feel pain or discomfort. Pain medications will be adjusted until you are comfortable.

You may still have the breathing tube in your mouth at this time, and you will be unable to talk with it in place. You may feel as though you are choking and this is normal. Once removed by hospital staff, you will be able to talk. Your throat may be sore for a few days, and this is very common. Your mouth may also feel dry—you may have ice chips.

You may have a number of tubes including IV lines, chest tubes, a bladder catheter, and oxygen. If you are having any pain or nausea, please let the nurse know. There are many medications which

can help relieve these symptoms.Once you are fully awake, you will be moved to your hospital room whereyourfamilycanvisityou.Totalrecoverytimecantakeupto3hours.

LaterthatNight:Your health team will continue to check on your progress. The nurse will help you sit up and take you for a short walk. Moving may be uncomfortable, but pain should be controlled by medications. Do your breathing exercises at least once an hour while you are awake to help prevent pneumonia and other post-operative complications.Use a pillow to support your chest when you cough. Ask a nurse to show you how to do this.

Your Hospital Stay

ExpectationsOvertheNextFewDays:Yourhealthcareteamwillcontinuetomonitoryourprogressfrequently.Chesttubeswillstayinuntil your lungs have healed. Your epidural catheter and bladder catheter will be removed within approximately 5 days. You will start eating on a liquid diet and advance to a solid diet. Breathing exercises are important the entire time you are in the hospital. Use your “breathing buddy” every hour while you are awake, 15-20 repetitions.

Walking up and down the hallways is also important to prevent complications such as pneumonia and helps to lower your risk of developing blood clots in your legs. You may use your arms as you normallywould.Trytositupasmuchaspossible,andusethebedforsleepingonly.

Pain Management:Your health care team will work diligently to control your pain. You may receive medications by mouth, through your IV, or through the epidural catheter. You may also have a local pain patch. Discomfort is normal, and it should not interfere with your walking or breathing exercises. Your nurse will help adjust your medications.

Pain medications often cause constipation. For this reason, you will be on a stool softener and possibly a laxative while in the hospital. Once you are sent home, you will be given oral pain pills. You are encouraged to continue stool softeners at home while taking pain medications.

PLEASELETYOURNURSEKNOWIF •YoufeelpainatanyIVsite •Youfeelfeverishorchilled •Noticeanybleedingfromthebandages

Once you are Home

•Thedressingthatcoverswhereyourchesttubeswereshouldremaininplacefor48hours

•Swellingaroundyourincisionwillgoawayoverthenextmonth •Feelingsoreiscommonandwillgraduallygetbetteroverthenextseveralmonths. o A prescription for pain pills will be given to you. •Itiscommontofeeltiredorfatiguedforupto6-8weeksfollowingyoursurgery •Theareaaroundyourincisionorthefrontofyourchestmayfeelnumb,oryoumay

have unusual sensations of tingling or sharp pains—these feelings are normal and will subside over time

•Clearyelloworpinkdrainageiscommonfromyourchesttubesite oCleanthisareadailyandkeepadrydressingoverituntilthedrainagestops o Wash all incisions daily and pat to dry •Womenmaywanttowearanathletic-typesupportbrawithfronthooksforincreased

comfort •Eatawell-balanceddiet—yourappetitewillincreasinglyreturntonormal •Drinkingplentyofwaterwillhelppreventconstipationalongwiththestoolsofteners oLaxativesorfibertabletsmayalsohelp •DoNOTliftanythingover20poundsfor4-6weeks •DoNOTsitinabath,hottub,orjacuzziuntilyourincisionsarecompletelyhealed •Avoidactivitiesthatcanoveruseyourarmandshouldermuscles oExamplesareswimming,golf,tennis •DoNOTdriveforatleast2weeksormoreifyourincisionispainfulorifyouarestill

taking pain medications •DoNOTdrinkalcoholwhiletakingpainmedications •Weencourageyoutocontinuenottosmokeandavoidotherswhodo! •Walkatleast4timesaday,startingonflatground,buildingupenduranceand

increasing your activity as tolerated oThegoalistowalk1/2mileperday,graduallyincreasingasyoufeelcomfortable o Walk around the house if the weather is bad •Continueusingyourincentivespirometereveryhourwhileawakeforatleast2weeks—

breathingexercisesarestillimportant!

Very Important

•Temperature>101F•Increasedshortnessofbreath•Rednessorbad-smellingdrainingfromincisionsite•Ifthereisanemergency,pleasecall911orgotoyournearest emergency department

Follow-up is a very important part of your overall surgical care. A post-operative visit is necessary approximately 1 month after your surgery. You will also need a chest x-ray before thisappointment.Yourprimarycaredoctor,pulmonologistand/oroncologistmayalsowantto see you.

Please contact Tennessee Thoracic Surgical Specialists at 615-222-1270 to arrange this appointment.

Meet our Staff

LaurenA.Combs,PA-CLaurenisourcertifiedPhysicianAssistant.SheisaNashvillenativeandreceivedherBachelor’sofSciencein Biology from Samford University. She continued her educationatTreveccaNazareneUniversityearningherMaster’sinMedicine;shebecamecertifiedbytheNCCPAshortly after graduation. She is also an active member

DeShea WallaceDeSheaisourPatientServicesCoordinator.Sheattended MiddleTNStateUniversity,completingaCNTprogramwiththeMedicalCareerCollege.DeSheahasworkedwithDr. Wudel for the past year. She handles all of your of the AAPA.LaurenworksdirectlywithDr.Wudelinprovidingpatient care, and she has a passion for patient education.

Alan DunnAlanisourMedicalAssistant.HeisaKaplanUniversitygraduateandisregisteredandcertifiedwithNAMP.Alan’sexcellent patient care skills are an asset to help you with all of you clinical needs and concerns.

4230 Harding Road, Suite 530 | Nashville, TN 37205 | p: 615.222.1270 | www.tnthoracic.com