Pneumonectomy

Key takeaways

Pneumonectomy belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Pneumonectomy to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Pneumonectomy from memory before moving on to harder problems.

Reference excerpt

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. It was first successfully performed in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. There are two types of pneumonectomy: simple and extrapleural. A simple pneumonectomy removes just the lung. An extrapleural pneumonectomy also takes away part of the diaphragm, the parietal pleura, and the pericardium on that side.

Indications The most common reason for a pneumonectomy is to remove tumorous tissue arising from lung cancer. Other reasons can arise are a traumatic lung injury, bronchiectasis, tuberculosis, a congenital defect, and fungal infections.

Contraindications

Tests The operation will reduce the respiratory capacity of the patient, and before conducting a pneumonectomy, survivability after the removal has to be assessed. If at all possible, a pulmonary function test (PFT) should be done. It has been found that forced expiratory volume in one second (FEV1) and diffusion capacity of the lungs (DLCO) provides the best indicator of survival. Other tools can be used to assess effectiveness as well, such as cardiopulmonary exercise testing to measure maximal oxygen consumption (VO2 max), stair climbing, shuttle walk test, and a 6-minute walk test.

Pathologies If someone has severe valvular disease, severe pulmonary hypertension, or poor ventricular function or if cancer has spread from the lungs into the other intra-abdominal structures, ribs, or contralateral hemithorax, it is contraindicated.

Surgical approach Posterolateral thoracotomy using the fourth or fifth intercostal space is the most common approach used for pneumonectomy. In case of inflammatory and infectious indications, excision of the fifth rib may be necessary to achieve adequate surgical exposure if there is rib crowding. Video-assisted thoracoscopic surgery (VATS) approach: VATS pneumonectomy is a safe and feasible treatment for advanced malignant and benign diseases and has lower morbidity. Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With a sound technique most procedures can be completed robotically without any major complications.

Anatomical changes After a pneumonectomy is performed, changes in the thoracic cavity occur to compensate for the altered anatomy. The remaining lung hyperinflates as well as shifting over along with the heart towards the now empty space. This space is full of air initially after surgery, but then it is absorbed, and fluid eventually takes its place. The fluid which fills the residual space in the chest cavity slowly gelatinizes into a proteinaceous material, and the chest scaffold collapses slightly.

Living with one lung As with the kidneys, it is often possible for a person to live with just one lung. Although it is not possible for the lung to re-grow like the liver, the body is able to compensate for the reduced lung capacity by slow and gradual expansion of the other remaining lung. Post-pneumonectomy patients in due time reach about 70–80 percent of their pre-surgery lung function. People have been able to return to near-normal lives, including running marathons after a pneumonectomy, provided there has been adequate cardio-pulmonary conditioning.

Complications Most common complications after a pneumonectomy are:

Cardiac arrhythmias Pulmonary complications like pneumonia, atelectasis, respiratory failure Bronchopleural fistula Injury to the diaphragm, liver, spleen, or a major vessel Postpneumonectomy pulmonary edema Postpneumonectomy cardiac herniation

History

Pioneering dates 1895: first pneumonectomy in multiple stages by William Macewen on a patient with tuberculosis and emphysema 1912: first anatomical dissection lobectomy by Hugh Morriston Davies 1918: first successful lobectomy, by Harold Brunn 1931: first successful pneumonectomy in two stages by Rudolph Nissen on a patient with crush injury to the thorax 1933: first successful single-stage total pneumonectomy by Graham and Singer 1939: first segmentectomy, by Churchill and Belsey

See also Medical ventilator List of surgeries by type

References

External links

Fuentes PA (April 2003). "Pneumonectomy: historical perspective and prospective insight". Eur J Cardiothorac Surg. 23 (4): 439–45. doi:10.1016/s1010-7940(03)00117-9. PMID 12694756.

Illustrations

Worked examples

Example 1 — a first encounter with Pneumonectomy

Start with the simplest possible case. Write down what Pneumonectomy claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Pneumonectomy before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Pneumonectomy ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Pneumonectomy

In research: Pneumonectomy appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Pneumonectomy in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Pneumonectomy is common in secondary-school and first-year university syllabi. It links to neighbouring topics Lung cancer, Pulmonary thoracic surgery, Surgical oncology, so understanding it makes those chapters shorter.
In everyday life: Look for Pneumonectomy outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

How to study Pneumonectomy in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Pneumonectomy means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Pneumonectomy out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Pneumonectomy in simple terms?

A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung. It was first successfully performed in 1933 by Dr.

Why does Pneumonectomy matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Pneumonectomy?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Pneumonectomy.