Information for Patients Undergoing a Thoracoscopic Wedge/Lobectomy
Prior to Surgery
- Do not take any nonsteriodial anti-inflammatory medication (i.e. Motrin Ibuprofen, and Aleve) or Aspirin products for 1 week prior or your surgery date.
- Do not smoke at least 2-3 weeks prior to your surgery; you may be tested the day of your surgery to make sure you have not been smoking; if you are smoking your surgery will be canceled.
- DO walk up to 2-3 miles a day prior to surgery to get yourself in the best shape possible
- DO use you incentive spirometer, at least 30 times a day (slow breaths,) and DO bring your incentive spirometer with you the day of your surgery. You can leave it with your family member or friend until after surgery, or you can leave it in the car until after surgery, when your friend/family member can get it and bring it to you.
- DO bring your blue blood sheet with you the day of surgery.
In the hospital/immediately after surgery
You will have a few tubes and lines in after surgery all of which are important and will be monitored while you are in the hospital.
- Chest tube- this is a tube that is used to drain the liquids that are produced in your lung normally, that may/will increase after we have removed part of your lung. It is also used to remove air that may be collecting in your chest after surgery, which is related to the surgery. "Air leaks" as we call them can happen for various reasons. We will show you while in the hospital the different parts of the chest tube "box" so you are aware what we are monitoring, with regards to an air leak, or increased drainage. Most of the time both of these need to stop before we can safely remove the tube. There are times when we will need to place a special one way Heimlich Valve if you have an air leak that may take a little longer to resolve. You may go home with this one way valve; you will get special instructions if this is the case.
- PCA (Patient Controlled Analgesia) Pump - this is a special pump that is used to infuse pain medicine into your IV, you are able to control it. After 1-2 days, we will stop it and switch you to oral pain medicine.
- Foley catheter - this is placed into your bladder during surgery. It is used because most pain medicines "make your bladder go to sleep" for a period of time. Generally the foley stays in until the PCA pump is stopped.
- SCD (Sequential Compression Device) - these are used to keep the blood from pooling in your calf. If the blood sits there for a period of time without movement, it can cause a blood clot. Other ways to prevent blood clots after surgery include leg exercises such as ankle circles and pointing your toe to the ceiling then to the wall. You should do each 10 times every hour, on both legs. Most importantly you must walk after surgery (you may need some help getting up and out of bed the first few times).
- IV - this is used to give fluids during surgery and after if needed.
- Heart Monitor - most patients are placed on a heart monitor while in the hospital; this is done to watch for fast or irregular heart beat. This is generally related to low blood levels of certain elements or inflammation from surgery. This can usually be corrected with medication. You may feel like you have been running.
- Incentive spirometer (IS) - this is a breathing exercise device. Along with coughing and walking, it helps to prevent collapse of lung and pneumonia. We realize there is pain involved with surgery and the pain may make these tasks difficult. Please let us know if your pain is not well controlled. There are other medications we can try to make sure you are as comfortable as possible.
Managing my pain:
- You will be given a prescription for pain medication - DO NOT TAKE IT ON AN EMPTY STOMACH. If you choose to fill your prescription elsewhere ask to make sure it is a medication that can be filled at your local pharmacy.
- Pain medication can make you constipated. Please eat a high fiber diet, and take in plenty of fluids. If you have problems with your bowels while at home, you can try an over the counter laxative (Milk of Magnesia, Ducolax, Fleets enema) to help move your bowels. Please feel free to contact the office if you are having any concerns.
- It is very normal to have pain, and/or a burning sensation below your breast on the same side as the surgery. This discomfort is caused by irritation of the nerve endings near your incisions. The best way to help relieve this pain is to take a nonsteroidal anti-inflammatory medication (also know as NSAIDS) such as Motrin or Advil. Please note if you are on Prednisone you should not take any NSAIDS. Also if you have ever been told to avoid these medications please do not take them. If you take an NSAID please note you must take this medication with food. We would recommend Motrin or Ibuprofen 400mgs(an over the counter NSAID is 200 mg, so take 2 tablets) 2-3 times a day. You can take this in addition to your narcotic pain medication (Vicodin, Tylenol #3). You may also have been given a prescription for Ibuprofen; if so, you should not take additional over the counter Motrin/ibuprofen products.
- You can also use a heating pad (not directly on your skin) and warm showers to help with some of the discomfort. Many patients also find it may be difficult to sleep in their own bed after surgery, and make there way to a couch or Lazy Boy chair. This is not uncommon, and will get better with time.
Taking care of my Incisions:
You will have 3-4 incisions on your side about 1 inch in length. In the operating room, your incisions are closed with a dissolvable suture and/or "glue" to close the skin edges. Clean your incisions with warm soap and water daily. You may notice that there is a yellowish film around your incision; this is from the "glue". To remove the glue, you may use Vaseline or cold cream, and then wash your incision with soap and water. Do not let the Vaseline or cold cream stay on your incision for any period of time. Look at your incisions daily. If you notice signs of redness, drainage, swelling, or run a fever greater than 101.0 F you need to contact us. If your incision is in a place that you can not see, you should have someone look at your surgery site for you.
You may have a suture where the chest tube (drainage tube) was located; this suture needs to be removed 5-7 days after your chest tube is removed. Your family member or primary care doctor can remove it otherwise you can come back to us to have this suture removed. To remove it, pick up both ends, slip the scissors underneath, cut, and pull. It is a small purse string suture.
Activity and Restrictions:
- It is important to walk everyday, and use your incentive spirometer everyday.
- It is recommended that you limit lifting to 10 lbs for the first week after surgery. During the next week, try not to lift anything heavier than 25 lbs. After 2 weeks there are no restrictions.
- If you are driving a long distance, we recommend that you get out and walk every 2-3 hours to help prevent blood clots.