1. Pulmonary resection HUSSEIN ELKHAYAT , MD Click on this icon to listen to the lecture notes Assiut university Faculty of medicine Cardiothoracic surgery dept. 2. Definition operations done under general anaesthesia in which part or whole of the lung is removed. 3. Surgical anatomy of the lung 4. Segmental anatomy of the lung 5. Types of pulmonary resection Blebectomy Wedge resection Segmentectomy Lobectomy Bi lobectomy Pneumonectomy Extended pulmonary resection - sleeve resection - carinal resection 6. Subpleural blebs /blebectomy 7. Wedge resection 8. Segmentectomy 9. Lobectomy 10. Pneumonectomy 11. Indications of pulmonary resection Congenital: congenital lobar emphysema congenital adenomatoid cyctic malformation of a lobe. Traumatic: severely lacerated lobe. Inflammatory: Bronchectasis chronic non resolving lung abscess TB cavity destroyed lobe or lung. Neoplastic: resectable lung cancer pulmonary metastatectomy Lung volume reduction surgery: in ttt of emphysema. In preparation for lung transplantation: in end stage lung diseases. 12. Congenital cystic adenomatoid malformationCongenital lobar emphysema 13. Approaches for pulmonary resection Thoracotomy: postero-lateral thoracotomy in lateral decubitus position, anterior thoracotomy in supine position, Axillary thoracotomy posterior peri-scapular thoracotomy in prone position, bilateral anterior thoracotomy with or without transverse sternotomy in bilateral lung transplantation. Median sternotomy and parasternal approaches: very rare. Video-assisted thoracic surgery (VATS) (thoracoscopy): 14. Postrolateral thoracotomy 15. Axillary thoracotomy 16. VATS 17. Lung transplant 18. Complications of pulmonary resection Early (30 days complications): Acute postoperative respiratory failure, due to Pain (postoperative analgesia; local + general, is mandatory). Atelectasis & Pneumonia (chest physiotherapy, IV antibiotics, ? bronchoscopy). Pulmonary oedema (restriction of IV fluids, diuretics, chest physiotherapy). ARDS . Cardiac arrhythmia (AF in patients > 60 ys). Bleeding. DVT, pulmonary embolism, Infections: empyema, wound infection and dehiscence. persistent air leak (visceral, disruption of bronchial stump causing bronchopleural fistula), 19. Complications of pulmonary resection Late: chronic pain, chronic respiratory failure, post-pneumonectomy syndrome 20. THANK YOU Dr_khayat@Hotmail.com See this video on youtube for more operative details about VATS https://youtu.be/aegWclsbJvk