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Pleurodesis & Decortication
A pleurodesis can be done if fluid builds up around the lungs, a condition known as a pleural effusion.
A patient may experience shortness of breath, chest pain, and cough, if a pleural effusion becomes large.
Often, a pleural effusion is first drained with a needle, a procedure called thoracentesis. This is often done by a pulmonologist (lung doctor) or a radiologist.
If draining the fluid with a needle clears the lung space of all of the fluid and the fluid does not come back, then the thoracentesis is all that is needed.
If the fluid comes back, then needle drainage is not likely to clear up the fluid permanently. In such cases, a pleurodesis can be done.
The basic idea behind pleurodesis is to get the fluid out and to get the lung to stick to the ribs. That is, to get the lung filled back up with air and the surface of the lung to heal to the ribs.
If the lung heals well to the ribs, then the lung will not compress in and allow fluid to accumulate in the lung space.
If fluid has been in the chest for a significant period of time, the surface of the lung can become inflamed. When this occurs, the surface of the lung can become covered in protein.
Think of this rind as being similar to a scab that forms on a skin wound. It is made of proteins and helps protect the layer beneath it.
The rind, also called a cortex, matters because it acts like a net that traps the lung.
The lung is in a compressed state and the cortex prevents the lung from filling back up with air.
If a pleurodesis is performed and the fluid is removed, but a cortex remains on the lung, then the lung will not fill back up with air and thereby it will not fill the chest. Almost certainly the fluid will come back in such a case.
So, a decortication is often needed along with a pleurodesis. The word de-cortication refers to undoing the cortex, getting rid of the cortex. The decortication and pleurodesis can be performed under one anesthetic, together.
If pleurodesis or decortication need to be performed, an open method or a minimally-invasive method can be used.
A thoracotomy is the "usual" method for pleurodesis and decortication. An incision is made in the lateral chest, usually large enough for the surgeon to place his (or her) hands inside the chest.
This allows access to all areas of the chest, so the fluid and cortex can be removed.
A thoracotomy works very well for pleurodesis and decortication - the drawback is the pain that results from the large incision.
Most patients go to the ICU after operation, typically for 1 night.
Most patients are in the hospital 4-5 days after thoracotomy for pleurodesis and decortication.
Dr. Pool does not generally use a thoracotomy, but prefers to perform pleurodesis and decortication with a robotic approach.
A robotic method can be used for pleurodesis and decortication.
The method Dr. Pool uses involves 4 or 5 small incisions between the ribs, on the side of the chest. The ribs are not broken.
The fluid and cortex is removed, using the robotic video camera and the robotic instruments.
It usually takes Dr. Pool 1-2 hours to perform a robotic pleurodesis and decortication.
Most patients who undergo robotic pleurodesis or decortication do not need to go to the ICU after operation.
Most patients are in the hospital 3-4 days after robotic pleurodesis and decortication.
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