Lobectomy

The term lobectomy (Latin lobus = lobe and Greek ἐκτομή, ektomế, " cut out " ), also called lobar are referred to in the surgery, the surgical removal of an organ lobe.

Description

As organs for a lobectomy primarily affects the lungs, the liver, the thyroid and the cerebrum come into question.

Lobectomy of the lung

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

Since the individual lobes of the lungs are surrounded by a separate Pleuraschicht, resulting from the removal of a lung lobe, only comparatively small wound surfaces in the lungs. The resulting after removal of the lobe clearance in the chest is compensated by an overstretching of the residual lung, a high- stepping on the diaphragm and a shift of the mediastinal area ( mediastinum ) again. In a bronchial carcinoma (lung cancer ) lobectomy of the most commonly performed surgical procedure is to remove the primary tumor. For peripheral malignant tumors of tumor classes T1 and T2 ( <5 cm maximum tumor extension ) lobectomy is the surgical procedure of choice. A lobectomy of the lung is a serious intervention. The operative mortality rate is despite significant progress in the classic open surgical lobectomy in 1 to 4%. In the open lobectomy of the chest is opened with a great cut. The pain is significant, and so the operated patients are usually at least a week after surgery in the hospital. In the minimally invasive VATS lobectomy (VATS = video -assisted thoracic surgery = video-assisted thoracic surgery ), patients can often just two days after surgery, leave the hospital, the pain is significantly lower. The possibility of a VATS lobectomy is, however, subject to certain boundary conditions which go beyond the standard criteria for a lobectomy. Thus, for example, must also be given the ability of tolerating the Einlungenventilation. The maximum extent of the tumor must be less than 5 cm, there shall be no extensive pleural be present and the tumor must be no connection ( surgically called relationship) to the pulmonary hilum have. In addition there are contraindications such as obesity or chemotherapy or radiotherapy before surgery ( neoadjuvant therapy).

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

Per lobectomy distant lung tumor size in comparison to the engagement channel (diameter 3.7 cm).

Lobectomy of the liver

The removal of a liver lobe is a partial resection of the liver, which is called a lobectomy of the liver. In contrast to hemihepatectomy the liver is divided anatomically. Thus includes the left lobe with a left-sided lobectomy only the parenchyma, which is left of the falciform ligament hepatis ( sickle-shaped liver volume), while the left side hemihepatectomy two segments ( IVa and IVb) are of the right lobe removed as well.

Image of a lobectomy for removal of hepatocellular adenoma in the left lobe of the liver.

Lobectomy of the thyroid

The complete removal of one of the two lobes of the thyroid gland is called hemithyroidectomy ( gr ἡμισ = hemi = half ') called or lobectomy of the thyroid. The operation can classic open ( Fig. 1) or minimally invasively ( Fig. 2).

In comparison, a minimally invasive right side of the thyroid lobectomy.

Cerebral lobectomy

The partial or complete removal of a cerebral lobe is a neurosurgical procedure that is used primarily for the treatment of refractory epilepsy, ie epilepsy that does not respond to appropriate medications commonly used. A distinction is made between a

Bilateral lobectomy: removal of a cerebral lobe (partly ) in both the right and left Hirnhemisphere and a
Temporal lobectomy: on both or one-sided, complete or partial removal of a temporal lobe.

The most famous case study of a lobectomy in the cerebrum is the patient Henry Gustav Molaison, usually called in the literature HM. For him, a bilateral mediotemporale lobectomy was performed to treat his severe epilepsy, that is to say parts of the temporal lobe were located toward the center removed. His case was a milestone for memory research.

A cerebral lobectomy can be used as a last resort ( last resort ) for intracranial pressure reduction ( decompressive lobectomy ) are used.