Thoracic Surgery - Anatomy and Procedures

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Questions and Answers

What is a common indication for performing a pneumonectomy?

Chronic Pulmonary Emphysema

Invasive lung tumor (correct)

Lung Volume Reduction

Thoracotomy

Which of the following describes the lung volume reduction surgery?

Implementation of a thoracotomy approach

Use of a stapling device for entire lung removal

Complete removal of a lung

Resection of hyperinflated lung tissue (correct)

What is the most common incision type for thoracotomy?

Median sternotomy

Lateral thoracotomy

Anterolateral incision

Posterolateral thoracotomy (correct)

What device is frequently used to ligate the PA, PV, and bronchus during a pneumonectomy?

Stapling device (e.g., TA) Signup and view all the answers

What is a necessary requirement after a lung volume reduction surgery?

Chest drainage system Signup and view all the answers

What is the primary function of the bronchial arteries?

Supply nourishment to the lungs Signup and view all the answers

Which structures separate the right and left pleural cavities?

Mediastinum Signup and view all the answers

In which surgical procedures is the patient typically positioned laterally?

Thoracotomy Signup and view all the answers

What is the role of the visceral pleura?

Covers the outer surface of each lung Signup and view all the answers

What procedure can involve resection of mediastinal lymph nodes?

Diagnosis of lung malignancies Signup and view all the answers

Which component is essential in thoracic surgery for facilitating ventilation of one lung?

Double-lumen endotracheal tube Signup and view all the answers

What type of nerves are distributed throughout the thoracic cage?

Intercostal nerves Signup and view all the answers

Which of the following is NOT a basic consideration for perioperative nursing in thoracic surgery?

Surgical instrument sanitation Signup and view all the answers

What is the primary purpose of a double lumen endotracheal tube?

To collapse one lung for surgical procedures Signup and view all the answers

Which instrument is specifically used to visualize the mediastinum?

Mediastinoscope Signup and view all the answers

What type of surgical intervention can be directly associated with Video-Assisted Thoracoscopic Surgery (VATS)?

Lung lobectomy Signup and view all the answers

Which characteristic is true about a rigid bronchoscopy?

It allows for better tissue sampling than flexible bronchoscopy. Signup and view all the answers

How is the placement of the bronchial lumen confirmed during surgery?

Using flexible bronchoscopy Signup and view all the answers

What is a wedge resection performed during VATS intended to remove?

A wedge-shaped section around a lesion Signup and view all the answers

What is the primary function of a chest drainage system following a thoracic procedure?

To restore negative pressure in the pleural cavity Signup and view all the answers

Which type of lung resection involves removing an entire lung?

Pneumonectomy Signup and view all the answers

What is the difference between water-seal and gravity drainage systems in chest drainage?

Water-seal uses a one-way valve, while gravity does not. Signup and view all the answers

In which surgical approach is fine and blunt dissection particularly important for mobilizing lung tissue?

VATS lobectomy Signup and view all the answers

Study Notes

Anatomy of the Thoracic Cavity

Thoracic cavity contains right and left pleural cavities, separated by mediastinum.
Bronchial arteries provide blood supply to lungs, originating from the aorta.
Pulmonary arteries deliver blood to pulmonary parenchyma, while pulmonary veins return oxygenated blood to the left atrium.
Intercostal nerves are distributed throughout the thoracic cage, influencing sensory and motor functions.

Pleural Cavity Anatomy

Parietal pleura lines the inner surface of the pleural cavity.
Visceral pleura covers the outer surface of each lung, separating lung tissue from the thoracic wall.

Mediastinal Lymph Nodes

These nodes are located throughout the thorax and may be surgically resected for diagnosis of lung malignancies.

Perioperative Considerations

Key aspects include anesthesia management, patient positioning, instrument count, choice of instrumentation, and use of double-lumen endotracheal tubes (ETT) and chest drainage systems.

Patient Positioning

Lateral position is required for procedures like thoracotomy, VATS, and single-lung transplant.
Supine position is utilized for rigid bronchoscopy, mediastinoscopy, and sternotomy.

Instrumentation Overview

Open Thoracotomy requires major laparotomy trays and specialized thoracic instrumentation (e.g., lung retractors, rib cutters).
Minimally Invasive Surgery (MIS) utilizes VATS instrumentation for less invasive interventions.
Endoscopic instruments are designed for inspecting and cleaning the airways or performing biopsies.

Double Lumen Endotracheal Tube

Comprises two lumens; tracheal lumen collapses the operative lung, while bronchial lumen ventilates the non-operative lung.
Essential for procedures needing single-lung ventilation and placement is confirmed by flexible bronchoscopy.

Chest Drainage System

Used to drain air, blood, or fluid, restoring negative pressure in the pleural space post-operatively.
Proper sizing and correct pressure settings for drainage systems (e.g., Pleurovac) are crucial.

Surgical Interventions and Techniques

Endoscopic procedures including bronchoscopy (rigid and flexible) and mediastinoscopy for direct visualization.
VATS allows for diagnostics and therapeutic interventions with a minimally invasive approach.

Lung Resections

Various resections can be performed using the VATS approach: wedge resection, segmentectomy, lobectomy, pneumonectomy, and lung volume reduction surgery.

Wedge Resection VATS Approach

Involves removing a wedge of lung tissue, important for lesions or tumors, while ensuring adequate margins with adjacent normal tissue.

Lung Lobectomy VATS Approach

Removal of one or more lung lobes with careful ligation of associated pulmonary artery, vein, and bronchus using sutures/staples.

Pneumonectomy VATS Approach

Entire lung is removed, often due to invasive tumors, intrathoracic bleeding, or vascular anomalies.

Lung Volume Reduction Surgery - VATS

Targets hyperinflated lung tissue, particularly in chronic pulmonary emphysema, removing damaged tissue and sealing off using stapling devices.

Open Thoracic Surgeries

Thoracotomy is a large incision approach, most commonly via posterolateral thoracotomy, for extensive surgical access. Procedures include wedge resections and pneumonectomies.

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Description

This quiz focuses on the anatomy of the thoracic cavity, including the lungs, and the basic procedural considerations important for thoracic surgery. It also covers the use and indications for double-lumen endotracheal tubes in thoracic surgical procedures. Test your knowledge on these critical aspects of thoracic surgery.