In lung transplantation, the surgeon first per-
forms pneumonectomy and then transplants the
donor replacement lung. Thoracotomy entails a
hospital stay of up to 10 days, depending on the
kind of surgery, and a recuperation period of two
to four months though some people can return to
most of their normal activities within six to eight
weeks. Additional treatment, such as RADIATION
THERAPY or CHEMOTHERAPY for lung cancer, may
extend the recuperation period.
Surgical ProcedureThe doctor performs thoracotomy with the person
under general ANESTHESIA. The placement and
length of the incision depends on the kind of tho-
racotomy and the reason for performing it. The
incision must be between the ribs, and the sur-
geon must either spread the ribs (using an instru-
ment called a rib spreader) or remove a portion of
rib to gain access to the thoracic cavity. The sur-
geon removes the intended segment, lobe, or
entire lung, and places tubes that will drain air,
BLOOD, and other fluids during HEALING. The opera-
tion may take two to six hours, longer for lung
transplantation. The person then remains in the
recovery room until the anesthesia wears off, with
intensive nursing care to maintain BREATHINGand
other vital functions. Less invasive approaches
that use fiberoptic scopes and a smaller incision
are now an option, particularly for biopsies. Such
MINIMALLY INVASIVE PROCEDURESallow quicker opera-
tive times and recuperation.
Risks and ComplicationsBecause thoracotomy breaches the thoracic cavity,
there are significant risks involved with this opera-
tion. The most common are bleeding, infection, and
PNEUMOTHORAX. These risks are potentially life-
threatening though are usually readily treatable and
survivable. Complications include RESPIRATORY FAIL-
UREand RECURRENCEof the circumstance that made
the operation necessary. Removal of a complete lung
results in the remaining structures of the thoracic
cavity shifting position, which can alter HEARTfunc-
tion, gastric (STOMACH) function, and breathing.
Outlook and Lifestyle Modifications
Many people spend the first 48 to 72 hours fol-
lowing surgery in the intensive care unit (ICU).
MECHANICAL VENTILATIONensures that the remain-
ing lung structure inflates fully to provide ade-
quate oxygenation. As the healing process
progresses the affected lung (after lobar resection),
or remaining lung when the operation is pneu-
monectomy, expands to fill the thoracic cavity and
pulmonary function improves. Most people can
sustain strong pulmonary function with only one
lung when the remaining lung is healthy and
overall health is good. Lifestyle modifications and
prognosis (outlook) vary with the underlying
health condition.
See alsoSMOKING CESSATION; SURGERY BENEFIT AND
RISK ASSESSMENT.trachea The major airway leading from the
THROATto the LUNGS. The trachea extends about
four and a half inches from the top of the throat
to the center of the chest. The sternum (breast-
bone) in the front and the spine in the back pro-
tect the trachea for much of its length. The front
of the trachea arches more than the back of the
trachea, producing an oval rather than round
tubular structure with a diameter (from side to
side) of about an inch. The trachea terminates in
two branches, the right main BRONCHUSthat goes
to the right lung and the left main bronchus that
goes to the left lung.
The trachea is made of smooth MUSCLEtissue
along the back wall with 16 to 20 C-shaped bands
of CARTILAGErunning along its length. The cartilage
rings give the trachea stability and resistance
against the pressure of air flow into and out of the
lungs. Thousands of hairlike structures called cilia
line the inner layer of the trachea, the tracheal
epithelium. The cilia move in wavelike patterns to
push secretions and foreign matter, such as dust
and particles, out of the airways. The epithelial cells
secrete mucus, which keeps the inner trachea
moist. The mucus helps humidify the air as it flows
into the lungs, and lubricates the air’s passage. The
mucus also traps foreign material so the cilia can
sweep it from the airways. Coughing expels air rap-
idly and forcefully from the lungs, pushing SPUTUM
(pulmonary mucus and the debris it contains) into
the throat for removal from the body.
For further discussion of the trachea within the
context of pulmonary structure and functiontrachea 233