What is a radical neck dissection? when is it done?

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What is a radical neck dissection? The surgeon removes a block of tissue from the collarbone to the jaw and from the front to the back of the neck. The large muscle on the side of the neck that is used for rotating, flexing or extending the neck is also taken out, along with the major vein on the side of the neck. Sometimes, a less drastic operation, called a supraomohyoid neck dissection is done. This takes out only the lymph nodes, the tissue surrounding the nodes and a muscle at the front of the neck. Another technique, called a functional neck dissection, saves the muscles of the neck, taking out only the lymph nodes and tissues surrounding them.
What kind of incision is made with a radical neck dissection? The incision depends upon what the surgery is for. It can run from below the ear to the collarbone. Everything in the front of the neck on one side or on both sides may be removed. This may include the lymph nodes, blood vessels, nerves, and the salivary gland under the jawbone.

What types of lung surgery are there?

What are the various types of lung operations called? 

The three most common types of lung operations are thoracotomy, lobectomy, and pneumonectomy.

What is a thoracotomy? 

This is a major operation used as a diagnostic tool when other diagnostic tests have failed to locate the tumor or to clarify the nature or extent of the tumor. The operation is performed in the operating room under anesthesia. It involves opening up the chest on one side and examining the lungs and nearby areas, such as lymph nodes. To perform the procedure, the doctor removes a rib or goes between two ribs, just below the shoulder blade. His cut follows the curve of the ribs, going from the back just under the shoulder blade around to the front of the chest. He spreads the ribs apart so he can see and work in the area of the lung. If a tumor is found, an immediate examination of it is made by the pathologist. If his report shows that the cell type of the tumor is favorable for operating, the surgical removal lobectomy or pneumonectomy is usually performed immediately.

Thoracotomy Simulation

What is a lobectomy? 

A lobectomy involves the surgical removal of one lobe of the lung. The procedure for operating is similar to a thoracotomy.

Lobectomy of Lung - Minimally Invasive Approach to Lung Cancer Surgery


What is a pneumonectomy? 

A pneumonectomy is the removal of one lung. Again, this is a major operation done in an operating room with the patient under anesthesia and follows the same procedure as the thoracotomy.

Does the surgeon ever change his mind and not remove the lung? 

If the surgeon finds that the cancer has spread too far for him to remove it all or is in an area where removal is impossible, he may leave the lung intact and close the incision. Then radiation and chemotherapy will be used to help shrink the tumor growth.

Will the surgeon ever remove the lung even though the cancer cannot be totally removed? 

It depends on many conditions. If, for example, the tumor is causing serious bleeding and the patient is coughing up blood or if there is an infection with abscess formation, it may be necessary to remove the lung. X-ray therapy and chemotherapy will then be used to help reduce the remaining cancer.

How does the patient breathe during lung operations? 

Special equipment is used to assist breathing. The other lung continues to breath while the surgeon is working on the diseased lung.

After a lung operation, what happens to the space that's left in the chest? 

Like empty closets, the space manages to get filled up. Body fluid and scar tissue take up most of the room. Structures from the opposite side shift toward the side ofthe operation. The other lung expands a little. At the beginning there may be a feeling of one sidedness or emptiness on the side of the operation.

Where are the incisions made for a lung operation? 

They are made beneath and behind the shoulder blade, paralleling the ribs, and will not be visible unless the back is exposed, as in a bathing suit.

How long do most lung cancer operations take to perform? 

Approximately 2 to 5 hours.

When can I get out of bed? 

You will be up in from 1 to 3 days, depending upon the extent of the operation and your physical condition.

Will breathing be painful? 

Breathing may be painful for about a week after the operation.

Is the incision painful? 

Most people experience no pain. However some find that scars are sensitive for several months.

Can a patient breathe and live normally after the removal of one or two lobes of the lung? After the entire lung is removed? 

A patient can breathe and live normally after the removal of one or two lobes of the lung, except that there might be a slight restriction placed on strenuous physical exercise. Those with an entire lung removed tend to get short of breath when they exert themselves. However, at rest, they breathe normally. Therefore, it is necessary to restrict activity somewhat.

How long a hospital stay is necessary on the average? 

Most doctors will send their patients home barring complications in about 10 to 14 days.

Why am I asked to cough after the operation? 

Though it sounds cruel and though your entire insides hurt, coughing is necessary to dislodge secretions in the lungs. The nurse will explain just how it is done and will show you how to support the incision. Coughing is one of the most effective ways of keeping the lungs free of secretions and of avoiding complications. With any respiratory surgery done under general anesthesia, the area becomes dry and mucous plugs form at the lung bases. Coughing helps dislodge the mucus and helps prevent pneumonia.

Why are arm and leg exercises necessary following the operation? 

Since the thoracotomy incision usually runs under one arm, there may be a tendency to favor that arm and hold it close to the body. To prevent the arm and shoulder from getting tight, you can exercise them by bringing the affected arm up slowly in front of the body to shoulder height and extending it out to the side to shoulder height. Simple leg exercises should be performed while in bed to help prevent phlebitis. You will probably be wearing elastic stockings to help decrease the possibility of phlebitis.

What should I know about the chest drainage equipment? 

The tube is there to permit drainage of any air or fluid that accumulates during surgery and will usually remain in place after surgery for 2 to 4 days. The first few days the tube will drain bloody fluid. This is normal. Each day, the amount of drainage will decrease and the color will get lighter. The tube is sutured to the skin and will not come out during deep breathing or coughing. In fact, you will be encouraged to get up, to take deep breaths, and to cough. This will help the lung to expand and will force out the air and fluid that has accumulated in the lung area. The only caution you must take is not to allow the tube to kink up or to fold over, since this can cause pressure to build up in the chest, resulting in pain or shortness of breath. Removal of the tube will probably not hurt.

Why does it hurt when I lift my arms or take a deep breath? 

Sometimes this happens after lung surgery and is due to the surgery. Your nurse or doctor will instruct you in breathing deeply you will be encouraged to breathe each time to the point of pain. Amazingly enough, the pain on breathing will go away more quickly if you breathe deeply than if you try to prevent the lung pain by shallow breathing.

Will I be needing intravenous fluids? 

Probably, for at least 24 hours after the operation.

Can I catch lung cancer by kissing someone who has it? 

There is no indication that cancer can be "caught" by kissing a person. There is also no evidence to suggest that living in the same household with a cancer patient, sharing his or her possessions, or being physically intimate over a long period of time will increase a person's chances of getting cancer. You should not be afraid that you will "catch" cancer.

I have recently had an operation in which one lung was removed. I am very depressed and tired. I can't even climb the stairs without being short of breath. Does that mean that my cancer is worse? 

No. Many patients complain of fatigue after a lung operation. Remember that the body needs to repair itself after any operation and surgery in which a lung is removed is a major operation. Take time and rest and do not worry. When your body gets adjusted to having only one lung, you will be able to climb stairs more easily.

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