LOBECTOMY!!!

This morning I had the excellent opportunity to scrub in with Dr. S and see a right middle/lower lobectomy. This female patient was diagnosed with a carcinoid tumor.

So last night I prepared for this surgery by digging out my old anatomy books and looking up the relevant physical structures. In terms of cutting into the thoracic cavity, I reviewed which structures would be cut (skin layers, subcutaneous fat, muscles, intercostal space). I then reviewed the lung anatomy, artery and vein supply, the trachea, the lymphatics and other structures nearby (heart being the biggest). This morning I arrived early to look into the history of my patient. 57 year old female with 40 year history of smoking tobacco (and some occasional crack). I looked up her chest CT scan and saw where the tumor was localized (right posterior lower/middle lobe). And I was all prepared to answer any question that Dr. S asked me right?

Well, I got the first one; "What muscle is this that I am cutting through?" My answer: Latissimus Dorsi! Correct!!!! And I got the next question right; "What is that muscle's nerve supply? Long Thoracic Nerve! Correct!! But then it was downhill, because the next question was "Do you know the history of the first lobectomy/pneumonectomy?? And I said No. And so began Dr. S's hour long explanation into the history and its importance. I actually enjoyed it tremendously because it gave you an appreciation for how this procedure developed. So now I know that the first pneumonectomy was performed in 1933 by Dr. Graham on a Dentist from Pittsburgh who traveled to Barnes Hospital in St. Louis to have the procedure done. And I should mention that the Dentist was a smoker.....and so was Dr. Graham!!!

By the way, for those who can stomach it....the following University of Michigan video is very similar to the procedure I saw. Enjoy!!!
http://anatomy.med.umich.edu/surgical_videos/pneumonectomy.html

Have a great night!