Questions and Answers
What is a common indication for performing a pneumonectomy?
Which of the following describes the lung volume reduction surgery?
What is the most common incision type for thoracotomy?
What device is frequently used to ligate the PA, PV, and bronchus during a pneumonectomy?
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What is a necessary requirement after a lung volume reduction surgery?
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What is the primary function of the bronchial arteries?
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Which structures separate the right and left pleural cavities?
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In which surgical procedures is the patient typically positioned laterally?
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What is the role of the visceral pleura?
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What procedure can involve resection of mediastinal lymph nodes?
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Which component is essential in thoracic surgery for facilitating ventilation of one lung?
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What type of nerves are distributed throughout the thoracic cage?
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Which of the following is NOT a basic consideration for perioperative nursing in thoracic surgery?
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What is the primary purpose of a double lumen endotracheal tube?
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Which instrument is specifically used to visualize the mediastinum?
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What type of surgical intervention can be directly associated with Video-Assisted Thoracoscopic Surgery (VATS)?
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Which characteristic is true about a rigid bronchoscopy?
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How is the placement of the bronchial lumen confirmed during surgery?
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What is a wedge resection performed during VATS intended to remove?
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What is the primary function of a chest drainage system following a thoracic procedure?
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Which type of lung resection involves removing an entire lung?
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What is the difference between water-seal and gravity drainage systems in chest drainage?
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In which surgical approach is fine and blunt dissection particularly important for mobilizing lung tissue?
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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.
