Introduction to Lung Wedge Resection

Table of Contents 1 Pinyin 2 English Reference 3 Name of the Procedure 4 Classification 5 ICD Codes 6 Overview 7 Indications for Lung Wedge Excision 8 Contraindications for Lung Wedge Excision 9 Preparation 10 Surgical Procedures 11 Notes 1 Pinyin

fèi xiē xíng qiē chú shù

2 English Reference

wedgeshape excision of lung

4 Classification

Thoracic Surgery/TV Thoracoscopy/Lung Surgery

5 ICD Codes p> 3 Surgical name

wedgeshape excision of lung

4 Classification

Thoracic surgery/telethoracoscopic surgery/lung surgery

5 ICD code

32.2911

6 Overview

Wedgeshape excision of lung, also known as partial lung resection, is a common procedure for resection of a limited lung. Lung wedge resection can be used for limited lesions located in the periphery of the lungs that do not require or cannot undergo lobectomy. This operation is simple, easy to master, less traumatic, and has little effect on lung function. It is generally believed that wedge local resection is only suitable for tuberculosis ball or limited lesions that are pathologically confirmed as granulomas. With the development of VATS technology, certain lung parenchymal lesions that used to require open-heart surgery for diagnosis and treatment can be accomplished by thoracoscopic pulmonary wedge resection, lobectomy and total lung resection, and thoracoscopic-assisted emphysematous lung reduction surgery has also achieved better results in recent years.

7 Indications

1. Lung wedge resection is commonly used for peripheral tuberculosis ball, and sometimes can be used to cut limited lung tissue to clarify the diagnosis. Tuberculosis ball due to large lesions, surrounded by a fibrous envelope, no blood vessels in the necrotic tissue, the drug can not penetrate into the lesion, so the diameter is greater than 2cm, should be surgically resected.

2. Peripheral benign lung tumors.

3. Lung nodular lesions of undetermined nature or interstitial lung lesions that are difficult to diagnose.

4. Isolated pulmonary metastases.

5. T1N0M0 peripheral lung cancer with poor cardiopulmonary reserve that cannot tolerate open-heart surgery.

8 Contraindications

Wedge resection is contraindicated for non-superficial or peripheral lesions other than tuberculosis balloon.

9 Preparation

1. Determine the site of the lesion and learn about the healthy lung by X-ray.

2. If there is a combination of infection and high secretion, give anti-infection treatment and control the amount of sputum.

3. Smokers should avoid smoking for more than 2 weeks.

4. Lung function tests and blood gas analysis.

5. Correct cardiac function, improve systemic nutrition.

10 Surgical steps

Surgery is performed under general anesthesia with double-lumen intubation, taking a posterior lateral incision or anterior incision, entering the chest along the upper edge of the 5th or 6th rib or the ribbed bed, and performing wedge resection of the lungs, the gas in the alveoli around the lesion should be extruded by hand, and then the pulmonary lesion located at the edge of the lung should be wedge-shaped clamped shut with two large straight pliers, with the tips of the two pliers close to each other, and the vascular pliers are 1 to 2 cm away from the lesion, and then the wedge-shaped pulmonary tissue should be resected with the blades. Sent for examination, and then use fine silk thread to make multiple parallel mattress sutures, suture closure of the cut edge of the lung. If necessary, the outer edge of the suture line can be turned inside out and parallel mattress sutures can be performed, which can play a perfect role in hemostasis and prevention of air leakage. If very little lung tissue is removed, penetrating suture ligation is also feasible. If the lung section is treated with a suture, hemostasis is more complete and the result is better.

Benign smaller lesions confined to superficial parts of the lungs can be resected without regard to segmental distribution, directly after wedge clamping with two large hemostats [Figure 91]. The cut surfaces are each closed with a double continuous fine silk suture, with the first layer sutured around the hemostats, the suture tightened after removal of the hemostats [Fig. 92], and then the original suture returned to the head with the original suture, knotting the two threads to each other [Fig. 93].

91 Wedge clamp the diseased lung 92 Excise the diseased lung, wrap the hemostat around the hemostat for a 1st successive layer of sutures 93 Remove the hemostat, tighten the 1st layer of sutures, and return for a 2nd successive layer of sutures Fig. 9 Lung wedge resection 11 Precautions

1. Lung wedge resection is most often used for a limited borderline benign lesion or if the patient's cardiorespiratory fitness is too poor or if only biopsy is being performed for a definitive diagnosis.

2. Thoracoscopic lung wedge resection, the lesions in the lung parenchyma are difficult to locate, and the following methods are commonly used: ① from one trocar port with lung forceps to send the diseased lung to the other trocar port near the finger touch to locate the position; ② according to the preoperative CT suggesting the lesion area, gently squeeze the lung tissue with the lung lobe forceps to look for the lesion; ③ preoperative CT under the lesions puncture the metal wire or inject the blue dye to mark the location of the tumor.

3. Lung wedge resection is still controversial in the treatment of lung cancer, mainly because of the problem of local recurrence of lung cancer, and when performing lung wedge resection, attention should be paid to the margins of the lung without cancer residues.

4. Wedge resection of lung tissue should not be too much and too deep, otherwise it is easy to injure larger blood vessels or bronchial tubes, causing hemorrhage or bronchopleural fistula.