Pulmonary Resection

Anatomic resections of the lung (including pneumonectomy and lobectomy) are the standard operative techniques employed to treat both neoplastic and nonneoplastic diseases of the lung. Preoperative evaluation is described. Once assessment of sufficient pulmonary reserve to tolerate the procedure is made, guidance is provided for anesthesia (bilateral or unilateral lung ventilation); placement of catheters; positioning in the lateral decubitus position; and type of incision to be made (posterior lateral thoracotomy or small incisions). Special intraoperative issues are also touched upon, especially resections that begin with the finding of benign- or malignant-appearing adhesions. The operative techniques are described for a right and left hilar dissection; a right and left upper lobectomy; a right middle lobectomy; a right lower lobectomy; and a right and left pneumonectomy. For each technique described, the chapter addresses the anatomical considerations of the pulmonary veins and arteries; the fissure between the upper and lower lobes; and the bronchi. Figures indicate the various steps of the hilar dissection and upper, middle, and lower lobectomy of both the right and left lung