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Open lung surgery requires intubation and ventilation. Double lumen intubation allows one lung to be collapsed for surgery.
A lobectomy is used for lesions confined to a single lobe. The potential space created by the removal is filled with remaining lung, elevation of the diaphragm and mediastinal shift. Pneumonectomy is the removal of a whole lung usually due to a tumour. The hilar vessels are ligated and the bronchus is divided and closed close to the carina. The space resulting from the operation not occupied by shift of other structures fills with blood and serum which organises and fibroses.
Thoracoscopy is used for diagnosis of pleural disease, mediastinoscopy to sample upper mediastinal lymph nodes and mediastinotomy to sample lower mediastinal lymph nodes. Videoassisted thoracoscopic surgery (VATS) is increasingly used for minimal access surgery. Single lung ventilation is used to allow the collapse of the lung being operated on, e.g. for lung biopsy, overstapling of a bronchopleural fistula or pleurectomy.
Specific complications following thoracic surgery include pneumonia (related to intubation, ventilation and lung collapse), pneumothorax, haemothorax, empyema, pulmonary oedema and acute respiratory distress syndrome.
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