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| Lung Decortication |
Lung Decortication When empyema is present for more than 3 weeks (lung lobectomy ) the ability to perform an adequate decortication may be more difficult and dense adhesions due to the presence of lung visceral tear resistance Lung Decortication.
Patients with effusion or empyema fibrinopurulent almost always be treated with thoracoscopy lung removal, CT is not useful in predicting patients who require a thoracotomy .Lung Decortication Conversion to open thoracotomy is performed when necessary and should not be considered a failure of thoracoscopy , but rather an exercise of surgical judgment mature Lung Decortication .
Thoracoscopy is also indicated when the nature of undiagnosed pleural process , because it allows directed pleural biopsy is likely to get a diagnosis while avoiding the morbidity of a thoracotomy .lung removal Other indications for lung lobectomy thoracoscopic decortication include hemothorax and mediastinal debridement in patients with descending mediastinitis Lung Decortication .
Before thoracotomy Lung Decortication, pleurodesis with talc before and empyema are against previous relative contraindication to thoracoscopy . The inability to tolerate single lung ventilation and the presence of a fibrothorax are cons -indications to perform thoracoscopic decortication .Lung Decortication for Patients who develop empyema after perforation of the esophagus not be trained but thoracoscopy thoracotomy .
Lung Decortication 1: CT scan shows empyema
The CT scan provides information about the location, the degree of loculation lung removal , the extent of empyema and underlying lung parenchyma (Lung Decortication).
It is not uncommon for an organization to be named in the pleural fluid and lung lobectomy therefore the broad-spectrum antibiotic coverage should be initiated if the diagnosis of empyema .lung removal This can be changed if the data identifies a culture of the organization . Lung Decortication Antibiotics are continued during the perioperative period.
The assessment of Lung Decortication status should be performed and complementary feeding is initiated if necessary lung removal. Bronchoscopy should be done before deciding on the abstraction of endobronchial obstruction in the part of the lung that is trapped by the empyema .
Lung Decortication operating steps :
General anesthesia was established lung isolation is achieved by using a double-lumen endotracheal tube or a tube with a single lumen bronchial blocker Lung Decortication.
This allows the expansion and collapse of the lung, as needed during the shelling or lung lobectomy . Intraoperative monitoring includes arterial line pressure ,lung removal large bore intravenous access , a Foley catheter and pulse oximetry . The patient is positioned as a posterolateral thoracotomy .
Lung Decortication . Postoperative chest radiograph after decortication tanks with pleural drainage tube left in place.
Port the camera is placed in the seventh or sixth intercostal space in the line of the anterior superior iliac spine and just prior to this . VATS lung removal and / or hemothorax can be done by 2 or 3 port. The fitting work should be placed on the fifth intercostal space between the anterior axillary line and average.
(Lung Decortication) The intercostal incision should allow three fingers. A Weitlaner is used to remove the soft tissue . A third port can be placed subsequently positioned to allow access to the front of the pleural cavity.
Once the chest is introduced Yankauer suction is used to empty the breast or the blood spill ( Lung Decortication) and a finger is used to break simple loculations ( lung removal ) . The preoperative CT helps guide the pleural space first "blind" drain and make it work for thoracoscopic instruments.
Gelatinous fibrin deposits and blood clots are removed with clips curved ring forceps . Visceral pleural skin can debridement using the ring - forceps, a curette and peanut dissection as open decortication .
Lung Decortication After creating a space removal pleural fibrinous material is made on the side of the pleural cavity from the apex of the lung and proceed to the membrane, or vice versa. The miller and the clamping ring assembly are used to remove material fibrinous pleural cavity and clamping curette lung removal , groundnut and the ring is used to dissect the crust in the Lung Decortication.
On the underside of the pleural cavity which is useful for the identification and separation of the lower lobe of the lung from the membrane .lung lobectomy in This plan is developed previously and then leave the lungs to fill the throat once costodiaphragmatic is full peeling lung removal .
Then the back of the pleural cavity and lung debridement debarking underlying. The exhibition is scheduled rolling the previous patient. Finally, the anterior surface of the pleural cavity and debridement of the lungs where it is released to join the mediastinum Lung Decortication. This exhibition is supported by rolling the patient thereafter. Left in the care must be taken to protect the phrenic nerve.
Lung Decortication Intermittent pulmonary ventilation is used to assess the integrity of the dissection decortication as it progresses .
lung removal If no progress has been adequate or inadequate lung expansion to fill the chest, then you need to make the conversion to open decortication . Particular care should be taken with hemostasi
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