The thin membrane that lines the chest cavity and covers the lungs is called the pleura, and it can be removed during a pleurectomy. The pleura is made up of two layers: the parietal pleura, which lines the chest cavity, and the visceral pleura, which covers the lungs. The space between these two layers is known as the pleural cavity.
There are different types of pleurectomy procedures, and they may be performed for various reasons, including the treatment of conditions affecting the pleura. Pleurectomy may also be done as part of the treatment for certain lung diseases, infections, or tumors. The goal of pleurectomy is to remove a portion or the entirety of the pleura to address the underlying medical issue.
Indications
Pleurectomy is indicated in the management of pleural effusion, a condition where excess fluid accumulates in the pleural cavity, often causing difficulty breathing. Non-cancerous causes of pleural effusion, such as infections or inflammatory conditions, may also be treated with pleurectomy.
Pleurectomy may be part of the treatment plan for tumors originating in the pleura or metastasizing to the pleura. This can include mesothelioma or pleural metastases from other primary cancers. Pleurectomy may be considered for patients with fibrothorax, a condition characterized by the formation of fibrous tissue in the pleural space.
Contraindications
Patients who are in poor overall health, with significant comorbidities that increase the risks associated with surgery, may be considered poor candidates for pleurectomy.
Tumors that are deemed inoperable or unresectable may not be suitable for pleurectomy. Patients with severe pulmonary insufficiency, compromised lung function, or inadequate respiratory reserve may face increased risks during and after pleurectomy.
Individuals with unstable cardiovascular conditions or a history of cardiovascular events may be at higher risk for complications during surgery, making pleurectomy contraindicated.
Active infections, especially those affecting the chest or pleura, may increase the risk of postoperative complications. Patients with uncontrolled bleeding disorders or those at high risk of excessive bleeding may not be suitable candidates for pleurectomy.
Outcomes
Pleurectomy is performed to alleviate symptoms associated with pleural conditions, such as pleural effusion or fibrothorax. Successful pleurectomy can lead to a reduction in symptoms such as difficulty breathing, chest pain, or persistent cough.
Pleurectomy can improve lung function by addressing conditions such as chronic pleuritis or lung decortication, which may lead to better respiratory outcomes.
In cases where pleurectomy is performed to treat malignant conditions like mesothelioma or pleural metastases, the goal may be to remove or debulk the tumor. Pleurectomy can be effective in preventing recurrent pneumothorax by removing or sealing off areas of the pleura prone to air leakage.
Equipment
Scalpel
Scissors and Dissectors
Forceps
Needle Holders
Suction Devices
Rib Spreader
Electrocautery or Laser Instruments
Suture and Stapling Devices
Chest Tubes
Hemostatic Agents
Anesthesia Equipment
Patient Preparation
Informed Consent:
A comprehensive medical history is obtained, including information about existing medical conditions, previous surgeries, allergies, and medications.
Patient Positioning:
The patient is positioned in a supine (i.e., lying on the back) position on the operating table.
Both arms may be positioned alongside the body and raised on arm boards to allow access to the chest.
TECHNIQUE
Step 1: Incision
A thoracotomy incision is made, typically on the side of the chest affected by the pleural condition. The incision allows access to the pleural space.
Step 2: Rib Spreading
The ribs may be spread apart, or a rib may be removed to provide better access to the pleura.
Step 3: Pleural Exploration
The surgeon examines the pleural cavity to identify the extent of the disease, such as tumors, fibrous tissue, or effusions.
Step 4: Removal of Pleura
The surgeon then removes a portion or the entirety of the pleura, depending on the extent of the disease and the therapeutic goals.
Step 5: Closure of incision
After completing the pleurectomy, the surgeon closes the incision, and chest tubes may be inserted to drain any postoperative fluids.
Fig. 1. thoracotomy incisionFig 2. closure of incision
COMPLICATIONS
Excessive bleeding during or after surgery can occur and may require intervention, such as reoperation or blood transfusion.
Surgical site infections or infections within the pleural space can occur. Prophylactic antibiotics are often administered before surgery to reduce the risk.
Lung infections, leading to pneumonia, may occur, particularly if there is impaired lung function or difficulty clearing secretions postoperatively.
Collapse of lung tissue may occur, especially if the patient has difficulty expanding the lungs fully after surgery. Air may accumulate in pleural space, leading to a pneumothorax. This can happen during or after surgery and may require intervention.
Postoperative respiratory complications may include difficulty breathing, decreased lung function, or the need for prolonged ventilator support.
Damage to the thoracic duct during surgery can result in the leakage of chyle into the pleural space, leading to a chylothorax. Air leakage from the lungs into the pleural space may persist after surgery, requiring additional interventions.
The thin membrane that lines the chest cavity and covers the lungs is called the pleura, and it can be removed during a pleurectomy. The pleura is made up of two layers: the parietal pleura, which lines the chest cavity, and the visceral pleura, which covers the lungs. The space between these two layers is known as the pleural cavity.
There are different types of pleurectomy procedures, and they may be performed for various reasons, including the treatment of conditions affecting the pleura. Pleurectomy may also be done as part of the treatment for certain lung diseases, infections, or tumors. The goal of pleurectomy is to remove a portion or the entirety of the pleura to address the underlying medical issue.
Pleurectomy is indicated in the management of pleural effusion, a condition where excess fluid accumulates in the pleural cavity, often causing difficulty breathing. Non-cancerous causes of pleural effusion, such as infections or inflammatory conditions, may also be treated with pleurectomy.
Pleurectomy may be part of the treatment plan for tumors originating in the pleura or metastasizing to the pleura. This can include mesothelioma or pleural metastases from other primary cancers. Pleurectomy may be considered for patients with fibrothorax, a condition characterized by the formation of fibrous tissue in the pleural space.
Patients who are in poor overall health, with significant comorbidities that increase the risks associated with surgery, may be considered poor candidates for pleurectomy.
Tumors that are deemed inoperable or unresectable may not be suitable for pleurectomy. Patients with severe pulmonary insufficiency, compromised lung function, or inadequate respiratory reserve may face increased risks during and after pleurectomy.
Individuals with unstable cardiovascular conditions or a history of cardiovascular events may be at higher risk for complications during surgery, making pleurectomy contraindicated.
Active infections, especially those affecting the chest or pleura, may increase the risk of postoperative complications. Patients with uncontrolled bleeding disorders or those at high risk of excessive bleeding may not be suitable candidates for pleurectomy.
Pleurectomy is performed to alleviate symptoms associated with pleural conditions, such as pleural effusion or fibrothorax. Successful pleurectomy can lead to a reduction in symptoms such as difficulty breathing, chest pain, or persistent cough.
Pleurectomy can improve lung function by addressing conditions such as chronic pleuritis or lung decortication, which may lead to better respiratory outcomes.
In cases where pleurectomy is performed to treat malignant conditions like mesothelioma or pleural metastases, the goal may be to remove or debulk the tumor. Pleurectomy can be effective in preventing recurrent pneumothorax by removing or sealing off areas of the pleura prone to air leakage.
Scalpel
Scissors and Dissectors
Forceps
Needle Holders
Suction Devices
Rib Spreader
Electrocautery or Laser Instruments
Suture and Stapling Devices
Chest Tubes
Hemostatic Agents
Anesthesia Equipment
Informed Consent:
A comprehensive medical history is obtained, including information about existing medical conditions, previous surgeries, allergies, and medications.
Patient Positioning:
The patient is positioned in a supine (i.e., lying on the back) position on the operating table.
Both arms may be positioned alongside the body and raised on arm boards to allow access to the chest.
Step 1: Incision
A thoracotomy incision is made, typically on the side of the chest affected by the pleural condition. The incision allows access to the pleural space.
Step 2: Rib Spreading
The ribs may be spread apart, or a rib may be removed to provide better access to the pleura.
Step 3: Pleural Exploration
The surgeon examines the pleural cavity to identify the extent of the disease, such as tumors, fibrous tissue, or effusions.
Step 4: Removal of Pleura
The surgeon then removes a portion or the entirety of the pleura, depending on the extent of the disease and the therapeutic goals.
Step 5: Closure of incision
After completing the pleurectomy, the surgeon closes the incision, and chest tubes may be inserted to drain any postoperative fluids.
Fig. 1. thoracotomy incisionFig 2. closure of incision
Excessive bleeding during or after surgery can occur and may require intervention, such as reoperation or blood transfusion.
Surgical site infections or infections within the pleural space can occur. Prophylactic antibiotics are often administered before surgery to reduce the risk.
Lung infections, leading to pneumonia, may occur, particularly if there is impaired lung function or difficulty clearing secretions postoperatively.
Collapse of lung tissue may occur, especially if the patient has difficulty expanding the lungs fully after surgery. Air may accumulate in pleural space, leading to a pneumothorax. This can happen during or after surgery and may require intervention.
Postoperative respiratory complications may include difficulty breathing, decreased lung function, or the need for prolonged ventilator support.
Damage to the thoracic duct during surgery can result in the leakage of chyle into the pleural space, leading to a chylothorax. Air leakage from the lungs into the pleural space may persist after surgery, requiring additional interventions.
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