Lobectomy

A lobectomy of the lung is performed in early-stage non-small cell lung cancer patients.{{cite journal | vauthors = Wright G, Manser RL, Byrnes G, Hart D, Campbell DA | title = Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials | journal = Thorax | volume = 61 | issue = 7 | pages = 597–603 | date = July 2006 | pmid = 16449262 | pmc = 2104670 | doi = 10.1136/thx.2005.051995 }}{{cite journal | vauthors = Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC | title = Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines | journal = Chest | volume = 143 | issue = 5 Suppl | pages = e278S–e313S | date = May 2013 | pmid = 23649443 | doi = 10.1378/chest.12-2359 | doi-access = free }} It is not performed on patients that have lung cancer that has spread to other parts of the body. Tumor size, type, and location are major factors as to whether a lobectomy is performed. This can be due to cancer or smoking. Lung lobectomies are performed on patients as young as eleven or twelve who have no cancer or smoking history, but have conditions from birth or early childhood that necessitate the operation.{{cite journal | vauthors = Downard CD, Calkins CM, Williams RF, Renaud EJ, Jancelewicz T, Grabowski J, Dasgupta R, McKee M, Baird R, Austin MT, Arnold MA, Goldin AB, Shelton J, Islam S | title = Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee | journal = Pediatric Surgery International | volume = 33 | issue = 9 | pages = 939–953 | date = September 2017 | pmid = 28589256 | doi = 10.1007/s00383-017-4098-z | s2cid = 41152831 }}{{cite journal | vauthors = Kazachkov M, Palma JA, Norcliffe-Kaufmann L, Bar-Aluma BE, Spalink CL, Barnes EP, Amoroso NE, Balou SM, Bess S, Chopra A, Condos R, Efrati O, Fitzgerald K, Fridman D, Goldenberg RM, Goldhaber A, Kaufman DA, Kothare SV, Levine J, Levy J, Lubinsky AS, Maayan C, Moy LC, Rivera PJ, Rodriguez AJ, Sokol G, Sloane MF, Tan T, Kaufmann H | title = Respiratory care in familial dysautonomia: Systematic review and expert consensus recommendations | journal = Respiratory Medicine | volume = 141 | pages = 37–46 | date = August 2018 | pmid = 30053970 | pmc = 6084453 | doi = 10.1016/j.rmed.2018.06.017 }} Such patients will have reduced lung capacity which tends to limit their range of activities through life. They often need to use inhalers on a daily basis, and are often classified as being asthmatic.{{cn|date=February 2022}}

Infectious Causes:When chronic lung infections don't improve with antibiotics, surgery may be needed. Tuberculosis is the most common reason for lobectomy worldwide. {{Cite journal |last1=Mitchell |first1=John D. |last2=Yu |first2=Jessica A. |last3=Bishop |first3=Amy |last4=Weyant |first4=Michael J. |last5=Pomerantz |first5=Marvin |date=April 2012 |title=Thoracoscopic Lobectomy and Segmentectomy for Infectious Lung Disease |url=https://linkinghub.elsevier.com/retrieve/pii/S0003497512001051 |journal=The Annals of Thoracic Surgery |language=en |volume=93 |issue=4 |pages=1033–1040 |doi=10.1016/j.athoracsur.2012.01.012|doi-access=free }} In select cases with complications like cavities or localized bronchiectasis, surgery can be performed after medical treatment, though it comes with higher risk and requires careful follow-up.

Non-Infectious Causes:Lobectomy may be used to treat congenital lung defects such as bronchial atresia, pulmonary sequestration, or cystic lung malformations.{{Cite journal |last1=Choi |first1=Min Suk |last2=Park |first2=Joon Suk |last3=Kim |first3=Hong Kwan |last4=Choi |first4=Yong Soo |last5=Kim |first5=Jhingook |last6=Shim |first6=Young Mog |last7=Kim |first7=Kwhanmien |date=2011-04-14 |title=Analysis of 1,067 Cases of Video-Assisted Thoracic Surgery Lobectomy |journal=The Korean Journal of Thoracic and Cardiovascular Surgery |language=en |volume=44 |issue=2 |pages=169–177 |doi=10.5090/kjtcs.2011.44.2.169 |pmid=22263146 |pmc=3249295 |issn=2233-601X}} It’s also an option for controlling severe bleeding (hemoptysis) caused by conditions like aspergilloma or vascular abnormalities. In trauma cases involving damage to major lung vessels or airways, lobectomy may be life-saving but carries a high risk of complications.

Cancer-Related Causes:Lobectomy is the preferred surgical treatment for Stage I–II non–small cell lung cancer, most commonly performed on the right upper lobe. It can also be used for certain rare tumors or when cancer has spread to a limited area of the lung.{{Citation |last1=R Hadassa |title=Mangroves: Treasure of novel bioactive compounds |date=2025-01-19 |work=Deep Science Publishing |pages=54–58 |url=https://doi.org/10.70593/978-93-49307-18-6_6 |access-date=2025-04-13 |isbn=978-93-49307-18-6 |last2=Kumari |first2=M Aruna |last3=T Vijaya|doi=10.70593/978-93-49307-18-6_6 |url-access=subscription }}

Patient selection plays a key role in lobectomy outcomes. Individuals with poor lung function (FEV1 under 800 cc or DLCO below 40%) are considered high-risk and may be better suited for limited resection or non-surgical options. Lobectomy is also not recommended for people who have had recent heart attacks, serious heart conditions, or large tumors over 6 cm, due to increased difficulty and risk.

A VATS lobectomy (Video-Assisted Thoracoscopic Surgery lobectomy) is a minimally invasive procedure used to remove a lung lobe, commonly for treating lung cancer or other pulmonary conditions. {{Cite journal |last1=Yan |first1=T. D. |last2=Cao |first2=C. |last3=D'Amico |first3=T. A. |last4=Demmy |first4=T. L. |last5=He |first5=J. |last6=Hansen |first6=H. |last7=Swanson |first7=S. J. |last8=Walker |first8=W. S. |last9=on behalf of the International VATS Lobectomy Consensus Group |last10=Casali |first10=G. |last11=Dunning |first11=J. |last12=Shackcloth |first12=M. |last13=Shah |first13=R. |last14=Stamenkovic |first14=S. |last15=Routledge |first15=T. |date=2014-04-01 |title=Video-assisted thoracoscopic surgery lobectomy at 20 years: a consensus statement |url=https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezt463 |journal=European Journal of Cardio-Thoracic Surgery |language=en |volume=45 |issue=4 |pages=633–639 |doi=10.1093/ejcts/ezt463 |issn=1010-7940|url-access=subscription }}

Instead of the large incision required in traditional open surgery, the surgeon makes 2 to 4 smaller incisions in the chest, typically ranging from 1 to 2 centimeters in length. Through these incisions, a small, flexible camera known as a thoracoscope is inserted, along with specialized surgical instruments. The thoracoscope is equipped with a high-definition camera that captures detailed images of the inside of the chest. These images are transmitted in real-time to a monitor, providing the surgeon with a clear, magnified view of the lung and surrounding structures. This enhanced visualization allows for precise and controlled movements during the procedure, enabling the surgeon to perform the lobectomy with greater accuracy and less disruption to surrounding tissues.

The advantages of VATS lobectomy include less postoperative pain, shorter hospital stays, smaller scars, and a quicker recovery compared to traditional open thoracotomy. However, it demands a high level of skill and experience, and patients with large tumors or widespread disease may require alternative surgical approaches. {{Cite web |title=Information and Resources about Cancer: Breast, Colon, Lung, Prostate, Skin |url=https://www.cancer.org/ |access-date=2025-04-13 |website=www.cancer.org |language=en}}

The first robotic-assisted lobectomies (RALs) were reported by Morgan and Ashton in 2003 who had performed them in adults in the United States and in Europe. Since then, the use of this technique has steadily increased. By 2015, more than 6,000 RALs had been carried out in the United States, with over 8,600 performed globally. {{Cite journal |last1=Linsky |first1=Paul |last2=Wei |first2=Benjamin |date=2017-09-30 |title=Robotic lobectomy |journal=Journal of Visualized Surgery |volume=3 |pages=132 |doi=10.21037/jovs.2017.08.12 |doi-access=free |pmc=5638995 |pmid=29078692}}

The da Vinci system, which is currently the only robotic system approved by the U.S. Food and Drug Administration (FDA) for performing lung surgery, improves on thoracoscopic surgery with 3D, high-magnification imaging and robotic arms that mimic wrist movement, filter tremors, and allow for precise tissue dissection and vessel control. {{Citation |last1=Chandra |first1=Raghav |title=Principles of Pulmonary Lobectomy |date=2023-03-08 |work=Essentials of Pulmonary Lobectomy |editor-last=Batıhan |editor-first=Güntuğ |url=https://www.intechopen.com/chapters/84217 |access-date=2025-04-13 |publisher=IntechOpen |language=en |doi=10.5772/intechopen.107342 |isbn=978-1-80355-570-6 |last2=de Hoyos |first2=Alberto|doi-access=free }}

Surgical resection is recommended for Stage I and II lung cancer, and selected Stage III cases, with lobectomy and lymph node evaluation as the standard approach. Preoperative assessments include imaging (CT, PET, EBUS or mediastinoscopy) and pulmonary function tests to ensure the patient can safely undergo surgery.[12] Robotic lobectomy is complex and not recommended for beginner robotic surgeons. It's advised to start with simpler Level I procedures (e.g., wedge resections, lymph node biopsies) before moving on to intermediate Level II cases and finally advanced Level III operations like lobectomies and esophagectomies. Early robotic lung resections should be carefully selected to ensure safety and support learning. Ideal early cases involve small (<5 cm), peripheral tumors with no lymph node calcification, complete fissures, normal bronchoscopy, and no prior chest surgery or radiation. As experience grows, more complex procedures can be added, with prior VATS experience being helpful but not required.{{clear}}

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Category:Surgical procedures and techniques

Category:Pulmonology