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A cat's lungs are divided into distinct lobes. When pathology affects a single lung lobe, then surgical removal may offer a means of improving the quality of life or even curing the animal. Lung lobectomy is an invasive procedure requiring entry into the chest cavity.
The procedure can be undertaken in first opinion practice or at a referral center. The latter has the advantage of auto-stapling devices which ligate blood vessels, close the bronchus, and cut tissue all in one move. This makes for swifter, less traumatic surgery, which is of benefit to the patient.
Cats requiring a lung lobectomy are often sick, and there are risks associated both with the anesthetic and surgery, plus there can be complications with postoperative air leakage into the chest cavity.
The extent of the problem is assessed with radiographs or an MRI scan, in order to plan the surgery. The patient's ability to withstand surgery is checked with screening blood tests. The cat is given a premed injection, including strong pain relief, and general anesthesia induced.
The patient lies with the affected side uppermost and the fur is clipped from the chest. Under aseptic conditions the surgeon makes an long incision between the ribs, and the muscles dissected so as to gain entry to the chest. Self-retaining retractors are positioned so as to widen the gap and provide good visualization of the lungs.
The diseased lung is identified. It is clamped as close to its origin on the bronchus as possible. The vascular bundle supplying the lobe is double ligated. The bronchiole is crushed flat between clamps and the lung removed. The stump of the bronchiole is then oversewn so that no air can leak out into the chest cavity. The clamp is removed and the chest wall repaired. A chest drain is placed, the skin sutured, and the cat woken.
Abscesses and pneumonia may respond to medical therapy, and surgery only resorted to for non-responsive patients. However, conditions such as a ruptured or twisted lobe are emergencies where only a surgical option will do.
Some surgeries, such as for foreign body removal, will be curative. This may also be the case for solitary lung tumors, provided the lump is not malignant and hasn't already metastised on a cellular level.
Lobectomy is a painful procedure and intensive care with strong pain relief may be required for four to five days after surgery. The patient is monitored during this time, to check for any leakage of air into the chest which would cause breathing difficulties. With the chest drain in place, these complications can be managed as necessary.
Once the patient is stable, the chest drain is removed and the cat discharged for strict home rest. The skin sutures are removed after 10 to 14 days.
Lung lobectomy is a skilled procedure that requires first class post-operative care. This is reflected in the cost, which is to be expected to be $2,000 upwards in first opinion practice, and $4,000 upwards at a referral center.
Lung lobectomy requires thoracotomy and is not without complications. Each rib is supplied with an artery and there is a risk of hemorrhage during surgery. In addition, if the bronchiole is not fully sealed, air can leak into the chest, which causes the lungs to collapse and respiratory distress.
On the plus side, successful lung lobectomy has the potential to save or extend life. Therefore the risks and benefits should be carefully considered and an informed decision made.
Many of the indications for lung lobectomy are not preventable.
It is important to carefully screen each patient to ensure that lung lobectomy is a proportionate response that will give the best outcome for the cat. This helps to prevent unnecessary surgery where other options such as medical therapy or even euthanasia, should be pursued.
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