Overview

The lungs are one of the main organs of the  respiratory system.The main function of the lungs is to bring oxygen into the body and remove carbon dioxide at the same time; a gas exchange known as respiration. Oxygen is absorbed into the bloodstream and is carried to the heart before being pumped to the organs and tissues, so the body can work properly. There are two lungs which are situated on either side of the chest.

However, if you have something wrong with your lungs, then you may need a lobectomy. Lobectomy is the term used for the surgical removal of a lobe (section) of the lungs. The right lung is divided into 3 lobes and the left lung is divided into 2 lobes. Even after the removal of one of the lobes, or even a complete lung, with the right follow-up care a person can live a normal and healthy life.¹

Understanding the lungs

The lungs are an organ located in the thoracic cavity, with the right and left lungs separated from each other by the heart and the structures in the mediastinum. Each lung rests on the diaphragm, with its apex extending superior to the clavicle, with both lungs covered in a protective layer known as pleural tissue.

• The right side lung is divided into three lobes; superior, middle and inferior 
• The left lung is divided into two lobes, the superior and inferior. In the left lung there is a part called cardiac notch where the heart is connected 

Conditions requiring lobectomy

Lobectomy is done when there is a disease in one or more lobes and removing the lobe helps stop the disease from spreading. Some of the diseases where a lobectomy is done are: 

• Lung abnormalities at birth
• Tuberculosis: An infectious disease that spreads through the air. It is curable if treated with antibiotics, but if left untreated it can be fatal
• Lung abscess: It is a microbial infection that results in the necrosis (death of the tissue) of the alveoli
• Emphysema: A condition that causes shortness of breath due to damages of the air sacs²
• Fungal infection: Fungal infections are commonly misdiagnosed, or diagnosed late, because the symptoms are very similar to  pneumonia
• Benign tumour: Tumours are an abnormal accumulation of tissues that occur when cells divide quickly and don’t die. A benign tumour is noncancerous  and doesn’t spread to other parts of the body
• Lung cancer: It occurs due to an abnormal growth of damaged cells, and generally shows no or limited signs and symptoms in its earliest stages. It commonly starts in the airways or small sacs of the lungs before spreading to other areas of the body^3,4

Lobectomy procedure details

Before the lobectomy

Before the lobectomy the surgeon will take a detailed medical history, and may order more tests to confirm the severity of the disease. A complete physical examination may be carried out to check for any physical signs caused due to the disease, or the appearance of a new disease.

Other tests that might be conducted are: 

• Complete blood test: This noninvasive test helps to spot any deficiencies (anaemia) or infections present in the blood
• Chest x-ray: This test uses x-rays to look at the heart, lungs and bones. It’s a useful technique when diagnosing conditions like pneumonia, emphysema or chronic obstructive pulmonary disease (COPD) 
• Computed tomography (CT) scan: It’s a noninvasive imaging test that helps  detect a disease or injury. It involves an x-ray and a computer giving detailed images of the bones and soft tissue
• Positron emission tomography (PET) scan: PET scans are noninvasive and work by observing radiation given off from a small amount of radioactive tracer injected into the arm. This provides a detailed 3 dimensional image of the inside of the body, creating images of different parts of the body 
• Pulmonary function test: By using a device called a spirometer, medical professionals can measure lung volume, capacity, rates of flow and air exchange
• Bronchoscopyendobronchial ultrasound guided biopsy: This helps to diagnose lung diseases like inflammation, infection and cancer. It’s done by a lung specialist called a pulmonologist, and involves using a flexible tube that goes through the mouth into the windpipe and the lungs. There is a camera with an ultrasound probe attached at the end to create the images of the lungs and nearby lymph nodes. The doctors will collect a sample using a small needle
• Transthoracic needle biopsy: By using a needle with the help of an ultrasound or CT scan, a tissue sample is obtained from the lungs⁵
• Electrocardiogram (ECG): It uses temporary electrodes on the chest and limbs to monitor the electrical activity of the heart
• Magnetic resonance imaging (MRI): Provides clear images of the inside of the body using large magnetic radio waves

Surgical techniques

During surgery the patient will be given a general anaesthetic so they won’t feel any pain. Most often surgeons will minimally invasive techniques because more invasive techniques can involve large incisions to spread apart the ribs to reach the lungs.⁶ 

The minimally invasive techniques are: 

• Video-assisted thoracoscopic surgery (VATS): This procedure helps diagnose and treat certain diseases like lung cancer or metastatic cancer. The doctor inserts a thin tube with a tiny video camera on the end (thoracoscope) into a small incision made in the chest. The surgeon removes the diseased tissue or organ before closing the incision with removable stitches or staples. This tissue is then examined under a microscope for the spread of cancer⁷
• Robot-assisted thoracoscopic surgery (RATS): This procedure is minimally invasive and is where a surgeon uses a console to control robotic technology. The surgeon views the images through the thoracoscope and guides the robotic surgical device to remove the diseased tissue or organ⁶

After the lobectomy

After the procedure the breathing tube used during surgery will be removed, and you will be moved to a recovery room. You’ll normally have 2 tubes in your chest to remove extra fluid and air from around the lungs, and will be removed based on drain output. You may receive shots in your  abdomen to prevent any blood clots forming in the legs while resting in bed. The doctor may also suggest coughing regularly to help your lungs recover and expand after surgery.

At home the doctor will ask you to keep the cut clean and dry and will suggest continuing breathing exercises and will advise to slowly increase your physical activity.  advised not to lift heavy items for a few months, as this is to prevent anystrain on the chest muscles and surgical site.

Risks of lobectomy

Lobectomy has many common side effects, such as: 

• Infection
• Heavy bleeding that requires the chest to be opened (thoracotomy) or the need for a blood transfusion
• Steady flow of air leaking from the lungs
• Formation of blood clots in the legs
• An irregular heartbeat
• Nerve injury that could affect the voice function

FAQs

Is lobectomy a major surgery?

Lobectomy is a major surgery, and death is rare, with 1% of people who have the procedure dying 30 days after. 

Can a person live a normal life after lobectomy?

Lobectomy has been helpful when restoring an individual's quality of life. 

What can you not do after a lobectomy?

After surgery the patient is advised not to drive for a while or to lift anything heavy until recovered.

How long will you need to stay in the hospital?

It may require staying in hospital for around 5 days, which is normal after a lobectomy. If there was a need for thoracoscopic surgery, then this hospital stay can be as long as 8 days.

Summary

Lungs, along with their tissues, help to make oxygen and remove carbon dioxide from the air inhaled. This oxygen is absorbed by the blood and is carried to the heart and pumped to the organs and tissues. There are two lungs which are situated on either side of the chest, with the right lung divided into 3 lobes and the left lung divided into 2 lobes. 

Lobectomy is the term used for the surgical removal of a lobe (section) of the lungs. Even after removing one or more lobes, or even the lung itself, the person can live a normal life. Lobectomy is most effective in the early stage of lung cancer.