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Lobectomy

By

Catherine Spader, RN

What is a lobectomy?

A lobectomy, also called pulmonary lobectomy or lung lobectomy, is the surgical removal of a lobe of a lung. You have two lungs divided into sections called lobes. Your left lung has two lobes and your right lung has three lobes. Your doctor may recommend a lobectomy to treat lung cancer or a lung lesion, which is abnormal tissue. After a lobectomy, your remaining lung lobes continue to function.

A lobectomy most often refers to a lobectomy of the lung. In some cases, the term may refer to a lobectomy of other organs, such as the brain, thyroid, pancreas or liver. 

A lobectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a lobectomy.

Other procedures that may be performed 

Your doctor may also remove nearby lymph nodes to examine them in the laboratory for cancer cells.

Types of lobectomy

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The types of lung lobectomy include:

  • Bilobectomy is the removal of two lobes.

  • Left upper lobectomy is the removal of the upper lobe of the left lung.

  • Left lower lobectomy is the removal of the lower lobe of the left lung.

  • Right upper lobectomy is the removal of the upper lobe of the right lung.

  • Right middle lobectomy is the removal of the middle lobe of the right lung.

  • Right lower lobectomy is the removal of the lower lobe of the right lung.

  • Sleeve lobectomy is the removal of a lobe and part of the air passage into the lung (bronchus). 

Why is a lobectomy performed? 

Your doctor may recommend a lobectomy to treat:

  • Bronchiectasis, which is scarring and widening of the airways in the lungs

  • Cancer that begins in the lung and is confined within one or two lobes

  • Congenital cystic adenomatoid malformation (CCAM), a noncancerous mass of abnormal lung tissue that is present at birth. Doctors generally recommend a lobectomy during infancy for this condition.

  • Fungal infections that are resistant to less invasive treatment

  • Lung blebs, which are large blisters in the lung that can cause it to collapse

  • Pulmonary sequestration, an abnormal type of lung tissue that develops before birth. This type of lung tissue does not function normally. Doctors generally recommend a lobectomy during infancy for this condition.

Who performs a lobectomy?

A thoracic surgeon performs a lobectomy. Thoracic surgeons specialize in the surgical care of the heart, lungs, trachea (windpipe), esophagus, diaphragm, and chest wall.

How is a lobectomy performed?

Your lobectomy will be performed in a hospital. Your surgeon will make an incision(s) between the ribs to remove the diseased lobe.  Your doctor will use one of the following approaches:

  • Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgery. Your surgeon will insert special instruments and a thoracoscope through three small incisions in your chest. The thoracoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the inside of your chest on the video screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Some surgeons use a surgical robot assist in minimally invasive surgery.

  • Open surgery (thoracotomy) involves making a large incision in the chest between the ribs. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

It is possible that your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery. 
Your surgeon may also decide after beginning a lobectomy that the entire lung needs removal. This is called a pneumonectomy. Your surgeon will staple off the lobe to be removed and tie any vessels that supply or drain blood to the lobe of the lung. After the specimen is removed, drains are placed to collect excess fluid from the lung and help to re-expand it. The incision(s) are closed with stitches or clips.  

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different lobectomy procedures and ask why your surgeon will use a particular type for you.

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Types of anesthesia that may be used

Your doctor will perform a lobectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. An epidural catheter (regional anesthesia) may also be placed to help with pain during and after the procedure.

What to expect the day of your lobectomy

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an intravenous (IV) line. 

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will insert a catheter in your bladder to monitor your kidney function. They will also insert a tube through your nose and pass it into your throat and stomach. This keeps your stomach empty during surgery. You will not feel or remember these procedures as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a lobectomy?  

As with all surgeries, a lobectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing 

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.

  • Infection and septicemia, which is the spread of a local infection to the blood. This includes pneumonia.

Potential complications of lobectomy

Complications of lobectomy include:

  • Abnormal heart rhythm

  • Buildup of fluid in the space left by the removed lobe 

  • Collapsed lung

  • Leakage of air into the chest between the lung and the chest wall

  • Moving of organs and tissue into the space left by the removed lobe

  • Respiratory failure and death

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include consultation with a registered dietician. 

  • Informing your doctor if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies 

How do I prepare for my lobectomy? 

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for a lobectomy by:

  • Answering all questions about your medical history and medications. This includes prescribed medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include an abdominal CT scan, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. 

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need lobectomy? Are there any other options for treating my condition?

  • What type of lobectomy procedure will I need?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my usual medications? 

  • How will you treat my pain?

  • What type of rehabilitation and physical therapy will I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my lobectomy?

Knowing what to expect can help make your road to recovery after lobectomy as smooth as possible. 

How long will it take to recover?

You may be transferred directly to an intensive care unit (ICU) after surgery. ICUs provide 24-hour intensive monitoring of all your body systems. How long you need to stay in the hospital varies depending on your age, medical history, diagnosis and other factors.

You will have a chest tube when you wake up from surgery. This is a tube that comes out through your chest to drain fluids, blood, and air. You team will remove these tubes as soon as possible. Until then, the team will keep you comfortable with pain medications and a mild sedative as needed.

You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You will need to avoid strenuous activity for six to eight weeks after surgery. 

During this time, you will likely participate in physical therapy and other therapies to help you recover. Rehabilitation therapies are important to helping your body compensate for the loss of part of your lung. They can improve circulation, endurance, strength, and lung capacity. Tell your doctor and therapists about all your activities and follow their instructions for returning to them.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery and breathing may be uncomfortable. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your or care team doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after a lobectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Pain that is not controlled by your pain medication, new pain, or pain that changes

  • Severe nausea and vomiting

  • Unexpected drainage, pus, redness or swelling of your incision

How might a lobectomy affect my everyday life?

A lobectomy may cure your condition so you can lead the most active, healthy life possible. However, many people who have had a lobectomy have ongoing shortness of breath. This can occur even without exertion. You may need to wear oxygen during certain activities and restrict the kinds of work and activities you do. Each case is different, so follow your doctor’s advice about your activities.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 12, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. A Patient's Guide to Lung Surgery. University of Southern California Keck School of Medicine. http://www.cts.usc.edu/lpg-typesoflungsurgery.html.
  2. Congenital cystic adenomatoid malformation. Children’s Hospital Boston. http://www.childrenshospital.org/az/Site2192/mainpageS2192P0.html.
  3. Lung Excision. MD Guidelines. http://www.mdguidelines.com/lung-excision.
  4. VATS Lobectomy for Early Stage Lung Cancer. The Cardiothoracic Surgery Network. http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-.html.
  5. Video-Assisted Thoracoscopic Surgery (VATS). Cedars-Sinai http://www.cedars-sinai.edu/Patients/Programs-and-Services/Lung-Institute/Conditions-and-Treatments/....
  6. Thoracoscopic lobectomy for prenatally diagnosed lung lesions. PubMed.gov. http://www.ncbi.nlm.nih.gov/pubmed/12677564.
  7. UC Irvine surgeon performs county’s first robotic lobectomy for lung cancer. UC Health. http://health.universityofcalifornia.edu/2011/04/06/uc-irvine-surgeon-performs-countys-first-robotic....
  8. Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.

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