Thoracoscopic Wedge Resection Periprocedural Care

Updated: Dec 16, 2015
  • Author: Dharani Kumari Narendra, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Patient Education & Consent

Patient education and consent

Informed consent should be obtained from all patients. A possible conversion to thoracotomy should be emphasized.

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Pre-Procedure Planning

Patient selection is a key for successful outcome in any thoracic surgery case.

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Equipment

Equipment involved in thoracoscopic wedge resection (TWR) includes the following:

  • Thoracoscope (5-mm or 10-mm scope with 0° or 30° lens)
  • Television monitor
  • Endoscope instruments
  • Endostapling/transection devices
  • Diathermy pen
  • Thoracotomy tray (on standby)
  • Suction source and tubing
  • Chest tube (30F)
  • Water seal drainage
  • Sutures
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Patient Preparation

Anesthesia

TWR requires general anesthesia provided through a double-lumen (preferable) or single-lumen tube with a bronchial blocker, in addition to single-lung ventilation.

For some solitary pulmonary nodules, resection is performed with a local thoracic epidural, although this is not universal.

Positioning

The patient is placed in the full lateral decubitus position with the nonoperative lung in the dependent position and operated side of the lung unventilated.

The operating table is flexed at midthorax to expand the intercostal space. The patient’s shoulder and arm are extended and secured to a side rest.

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Monitoring & Follow-up

Close intraoperative monitoring should include continuous pulse oximetry, capnography, mean arterial pressure, and heart rate.

Postoperatively, most patients are extubated in the operating room to prevent longer positive-pressure ventilation.

Postoperative pain management consists of narcotics and narcoticlike agents.

Early ambulation is recommended.

Early chest tube removal has been associated with reduced pain and increased lung function. [15]

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Complications

A potential anesthesia-related complication is hoarseness of voice.

Potential cardiac complications include arrhythmias and angina.

Potential pulmonary complications include the following:

  • Hemothorax
  • Persistent air leak
  • Subcutaneous emphysema
  • Wound infection
  • Ischemic necrotizing pneumonia
  • Nonobstructive atelectasis
  • Bronchopleural fistula
  • Local and port-site recurrence of malignancy [18] (more common with wedge resection than with lobectomy)
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