Lobectomy

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With the term lobectomy ( ancient Greek λοβός Lobos "rag" and ἐκτομή ektomế "cutting out"), even Lappenresektion called, is known in the surgery , the surgical removal of an organ lobe.

description

The main organs for a lobectomy are the lungs , the liver , the thyroid gland and the cerebrum .

Lobectomy of the lungs

The most common lobectomies are performed on the lungs , which is why the term lobectomy is often used synonymously in the literature for the surgical removal of a lung lobe. The human lungs have three lobes on the right (right lung) and two on the left (left lung). Removing a lobe from the lung is called a lobectomy. If, on the other hand, two adjacent lobes are removed from the right lung, this is called a bilobectomy . The removal of an entire lung is called a pneumectomy or pneumonectomy .

Since the individual lung lobes are surrounded by a separate pleural layer , only comparatively small wound areas are created on the lungs when a lung lobe is removed. The free space in the chest that arises after the removal of the lobe is compensated for by overstretching the remaining lung, stepping up the diaphragm and shifting the mediastinum . In the case of bronchial carcinoma (lung cancer), the lobectomy is the most frequently performed surgical procedure to remove the primary tumor . For peripheral malignant tumors of tumor classes T1 and T2 (<5 cm maximum tumor size), lobectomy is the surgical procedure of choice. A lobectomy of the lungs is a serious procedure. In spite of significant surgical advances, the operative lethality in the classic open lobectomy is 1 to 4%. In an open lobectomy, the chest is opened with a large incision. The pain is considerable, and the patients operated on in this way are usually in the hospital for at least one week after the operation. In the minimally invasive VATS -Lobektomie (VATS = video-assisted thoracic surgery , patients can = video-assisted thoracic surgery) often just two days after surgery, the clinic abandoned, the pain is significantly lower. However, the possibility of a VATS lobectomy is linked to certain boundary conditions that go beyond the standard criteria for a lobectomy. For example, the ability to tolerate one lung ventilation must also be given. The maximum tumor size must be less than 5 cm, there must be no extensive pleural adhesions and the tumor must not have any connection (surgically referred to as a relationship ) to the lung hilum . In addition, there are contraindications such as obesity or chemotherapy or radiation therapy before the procedure ( neoadjuvant therapy ).

  • Single-port video-assisted thoracoscopy (VATS) for lung lobectomy. Video image during the operation from the lower left mediastinum .

  • VATS for lobectomy viewed from the outside. The wound for inserting the tube has a diameter of only 2.5 cm.

  • Lung tumor removed by lobectomy compared to the size of the surgical canal (diameter 3.7 cm).

Liver lobectomy

Removal of a lobe of the liver is a partial resection of the liver called a lobectomy of the liver. In contrast to hemihepatectomy , the liver is divided anatomically. In a left-sided lobectomy, for example, the left lobe only includes the parenchyma , which lies to the left of the falciforme hepatis ligament (sickle-shaped liver ligament ), while in a left-sided hemihepatectomy two segments (IVa and IVb) of the right liver lobe are also removed.

  • Images of a lobectomy of the right lobe of the liver.

  • Image of a lobectomy to remove a hepatocellular adenoma on the left lobe of the liver.

Thyroid lobectomy

The complete removal of one of the two lobes of the thyroid gland is known as a hemithyroidectomy (Greek ἡμισ = hemi = 'half') or a lobectomy of the thyroid gland. The operation can be classically open (picture 1) or minimally invasive (picture 2).

  • A left-sided lobectomy of the thyroid gland after sternotomy to remove a calcified capsule on the left lobe of the thyroid.

  • In comparison, a minimally invasive right-sided lobectomy of the thyroid gland.

Cerebral lobectomy

The partial or complete removal of a cerebral lobe is a neurosurgical procedure that is used primarily to treat refractory epilepsy , i.e. epilepsy that does not respond to commonly used drugs. A distinction is made between one

  • bilateral lobectomy: removal of one (partial) cerebral lobe, both in the right and left cerebral hemisphere and one
  • Temporal lobectomy: bilateral or unilateral, complete or partial removal of a temporal lobe .

The most famous case study of a lobectomy on the cerebrum is the patient Henry Gustav Molaison , usually referred to as HM in the literature . For the treatment of his severe epilepsy, a bilateral mediotemporal lobectomy was performed, that is, parts of the temporal lobe in the middle were removed. His case was a milestone in memory research.

Cerebral lobectomy can also serve as a last resort (last resort) for intracranial pressure lowering ( decompressive lobectomy are used).

further reading

Individual evidence

  1. ^ A b Burkhard Paetz: Surgery. 21st edition, Georg Thieme Verlag, 2009, ISBN 3-13-332921-9 , p. 273. Restricted preview in the Google book search
  2. ↑ L. Sunder-Plassmann, C. Schuhmann: Malignant lung tumors. In: Jörg Rüdiger Siewert: Practice of Visceral Surgery. 3rd edition, Verlag Springer, 2010, ISBN 3-642-03807-7 , p. 433. Restricted preview in the Google book search
  3. ↑ L. Sunder-Plassmann, C. Schuhmann: Malignant lung tumors. In: Jörg Rüdiger Siewert: Practice of Visceral Surgery. 3rd edition, Verlag Springer, 2010, ISBN 3-642-03807-7 , p. 426. Restricted preview in the Google book search
  4. ↑ VATS lobectomy / VATS lobectomy. ( Memento of the original from January 7, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. University Hospital Erlangen, accessed on January 2, 2013 @1@ 2Template: Webachiv / IABot / www.thoraxchirurgie.uk-erlangen.de
  5. ↑ Peter Drings, Hendrik Dienemann, Michael Wannenmacher: management of lung cancer. Springer, 2003, ISBN 3-540-43145-4 , p. 248. Limited preview in the Google book search
  6. ↑ H. Wada, Y. Hida et al. a .: Video-assisted thoracoscopic left lower lobectomy in a patient with lung cancer and a right aortic arch. In: Journal of cardiothoracic surgery. Volume 7, 2012, p. 120, ISSN  1749-8090 . doi: 10.1186 / 1749-8090-7-120 . PMID 23147195 . PMC 3527347 (free full text).
  7. ^ CH Chen, SY Lee et al. a .: Technical aspects of single-port thoracoscopic surgery for lobectomy. In: Journal of cardiothoracic surgery. Volume 7, 2012, p. 50, ISSN  1749-8090 . doi: 10.1186 / 1749-8090-7-50 . PMID 22672719 . PMC 3431998 (free full text).
  8. ↑ Volker Schumpelick: Surgery Atlas. 2nd edition, Georg Thieme Verlag, 2006, ISBN 3-131-40632-1 , p. 231. Restricted preview in the Google book search
  9. ↑ Andreas Hirner, Kuno Weise: Surgery: cut by cut. Georg Thieme Verlag, 2004, ISBN 3-131-30841-9 , p. 523. Restricted preview in the Google book search
  10. ↑ Felix Braun, Thomas Becker and others: Liver. In: Doris Henne-Bruns: Dual series surgery. 4th edition, Georg Thieme Verlag, 2012, ISBN 3-131-51314-4 , p. 479. Restricted preview in the Google book search
  11. ↑ SA Gulec, K. Pennington u. a .: Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections. In: World journal of surgical oncology. Volume 7, 2009, p. 6, ISSN  1477-7819 . doi : 10.1186 / 1477-7819-7-6 . PMID 19133156 . PMC 2655298 (free full text).
  12. ↑ L. Sandonato, C. Cipolla et al. a .: Giant hepatocellular adenoma as cause of severe abdominal pain: a case report. In: Journal of medical case reports. Volume 1, 2007, p. 57, ISSN  1752-1947 . doi : 10.1186 / 1752-1947-1-57 . PMID 17662116 . PMC 1950307 (free full text).
  13. ^ Burkhard Paetz, Brigitte Benzinger-König: Surgery for nursing professions. 20th edition, Georg Thieme Verlag, 2004, ISBN 3-133-32920-0 , p. 243. Restricted preview in the Google book search}
  14. ↑ MF Yuzbasioglu, M. Ozkaya et al. a .: Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid. In: Cases journal. Volume 1, Number 1, 2008, p. 11, ISSN  1757-1626 . doi : 10.1186 / 1757-1626-1-11 . PMID 18577251 . PMC 2438315 (free full text).
  15. ↑ N. Irawati: Endoscopic right lobectomy axillary-breast approach: a report of two cases. In: International journal of otolaryngology. Volume 2010, 2010, pp. 958764, ISSN  1687-921X . doi : 10.1155 / 2010/958764 . PMID 21253488 . PMC 3022208 (free full text).
  16. ↑ a b Clemens Kirschbaum: Compendium Biopsychology. Springer, 2008, ISBN 3-540-39603-9 , p. 169. Restricted preview in the Google book search
  17. ^ M. Brand, HJ Markowitsch: Memory disorders. In: language, voice, hearing. Volume 27, Number 1, 2003, pp. 11-17. doi : 10.1055 / s-2003-37877
  18. ↑ Harald Barth, Ralph Schön: Neurosurgery. In: Doris Henne-Bruns: Dual series surgery. 4th edition, Georg Thieme Verlag, 2012, ISBN 3-131-51314-4 , p. 1138. Restricted preview in the Google book search