My Surgery: Lobectomy

Pre-Admission Visit

What should I bring to my pre-admission appointment?

• Your health card (OHIP card). If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver's license or passport.
• Any other insurance cards. You will need the policy number of your extended health insurance, if you have any.
• Your spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
• All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
• A copy of your power of attorney for personal care and/or advanced directives.
• A list of any questions that you may have about the operation and recovery.
• The name or phone number of your pharmacy, as well as any medical specialists that you have seen in the past 3 years.
• If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.

What happens during my pre-admission visit?

• You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
• You may also need an electrocardiogram (ECG) to check your heart and a chest x-ray to check your lungs.
• You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have.
• A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before your operation, taking your medications and pain management.
• A pharmacist will review your medications.

Depending on your needs, you may also meet:

• An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after your operation.
• A member of the medicine team, if you have other complex health problems.

1. Do not eat or drink after midnight on the night before your operation.
2. If you smoke, do not do so for 24 hours before your operation.
3. Do not drink alcohol for 24 hours before your operation.
4. Remove all nail polish and body piercings.
5. You must have a shower with soap and water to clean your skin the night before and the morning of your operation to reduce the chance of infection after your operation.

Stop smoking before your surgery: learn how smoking and tobacco can affect your recovery after surgery, and how quitting can improve your health.

What will happen right after my operation?

You will wake up in the Post Anesthesia Care Unit (PACU) and stay there for a few hours. Once you are ready to leave the PACU, you will be moved to the Thoracic Surgery & Respirology Inpatient Unit. Depending on your medical history, you may be required to spend one night in the Step-Down Unit (SDU) for close observation.

What can I expect to have on my body?

After your surgery, you will have:

Incisions, tubes or drains	What to expect
	Incisions: Your surgery will be completed either by a thoracotomy or by video assisted surgery (VATS). Your surgeon will tell you where and how big your incision (cut) will be. Thoracotomy: A thoracotomy means the incision is on your side. The incision will be anywhere from 8 to 25 centimetres (about 2½ to 10 inches) long. VATS: If you are having video assisted surgery (VATS), you will have 3 to 5 small incisions on your side. Each incision is about 2 centimetres (about ¾ of an inch) long. You will have 1 to 2 small incisions on your side for the chest tube(s). Each will be about 2 centimetres (about ¾ of an inch) long. Bandages cover your incisions. We remove them the following day after your surgery.
	Stitches or staples: Your surgeon usually uses dissolvable stitches to close your incisions. This means they go away on their own. If they are not dissolvable, your nurse usually removes the stitches or staples 14 days after your operation. If your stitches or staples need to remain in after you are discharged home, your family doctor can remove them. We will tell you if this is the case and give you a staple remover to take to your family doctor.
	Chest Tubes: You will have 1 to 2 chest tubes coming out of the side of your chest to remove air and fluid from the inside of your chest area.
	Heart monitor: You will be on a heart monitor while you are in the Step Down Unit.
	Urinary catheter: You will have a tube draining your bladder overnight.
	Intravenous (IV): You have an IV so we can give you fluids and medicines. It stays in until you are drinking well or you no longer need pain medicine through a pump.
	Arterial line: we use it to take blood samples without having to poke you with a needle. It also closely monitors your blood pressure.
	Oxygen: You may need oxygen after your surgery. At first, you will have an oxygen mask over your nose and mouth. When you no longer need the mask, you may get oxygen through your nostrils (nasal prongs).

How will I feel after my operation?

• A general anesthetic will make you feel sleepy for some time after the operation.
• You may have nausea and be sick to your stomach.
• During your surgery, you will also have a breathing tube in your throat that may cause your throat to be sore for a few days.

How can I manage my pain?

We will work with you to manage your pain. We can give you pain medicine in different ways:

Pain relief method	How it works
	Epidural: With an epidural, a doctor puts a small tube in your back. They usually do this right before your surgery. The tube is left in place to give you pain medicine after your surgery. It's attached to a pump, which gives you the medicines.
	Extrapleural catheter: This can be used to manage pain in patients who had a thoracotomy incision.
	Intravenous (IV) Patient Controlled Analgesic (PCA): A PCA pump is connected to your IV that gives you pain medicine through your IV when you push the button.
	Intravenous (IV) medicine: You get your pain medicine through an IV.
	Medicine by mouth: You may get your pain medicine in tablets that you swallow. This will happen once you are drinking fluids.

You will continue to recover when you return home.

Activity	How to manage at home
	Your appetite should return to normal within a few days. Try eating smaller meals more often. Drink plenty of fluids (at least 6 cups a day unless your doctor or dietitian gave you different instructions). Add bran, high-fibre breads and cereals, berries, dried fruit or prune juice to your diet (unless your doctor or dietitian gave you different instructions).
	Your doctor will prescribe you a stool softener while you are taking the pain medicine. You may also use a mild laxative if you need one.
	You can gradually increase your activity:. go for a walk at least once a day if you can. Wait 2 to 3 weeks before you swim. You can golf after about 3 to 4 weeks. Wait 4 to 6 weeks before you start jogging, playing tennis or racquetball, or doing aerobics. Talk to your surgeon before you do any skydiving or scuba diving.
	Keep your incisions clean and dry. Don't put lotions or creams on your incisions until they are completely healed. A possible "bump" along the incisions will decrease over 4 to 6 weeks. Most of your pain should be gone by 6 to 8 weeks after your surgery.
	You can shower once you get home, and you should shower each day. Use a mild soap, and let the water run over your incisions. Pat the incisions dry with a towel. Don't rub.
	You should expect to be off work for at least 4 to 6 weeks. Ask your surgeon when it's safe for you to return to work.
	Don't drive until you are off all pain medicine. You must be able to fully move your arm and shoulder before you can safely steer a car: usually about 3 to 4 weeks after surgery.
	No heavy lifting, carrying, pushing or pulling for 4 weeks. You can lift up to 10 pounds (about 5 kilograms).
	You can start having sex whenever you feel more comfortable (have less pain and more energy).
	Check with your surgeon about travelling. We usually recommend you not travel by air for 2 to 3 weeks after your surgery.

Where and when

Your surgeon's office and the Medical Imaging Department.

About 4 to 6 weeks after your surgery: if you don't have an appointment for a follow-up before you leave the hospital, call your surgeon's office the first week you are home.

What to expect

This appointment will let your doctor see how you are feeling. It is important for measuring your progress. On the day of your follow-up appointment, you will go to the x-ray department first to have a chest x-ray.

Who do I call with general post-operative questions?

Call your surgeon's office:

Also, call your surgeon's office if you notice the following symptoms:

• Have new redness or swelling around your incisions.
• Have pus (yellowish or white liquid) coming from your incisions.
• Feel increasing pain at your incisions.
• Have a temperature higher than 38.5°C (101°F).
• Have shortness of breath.
• Cough out mucous that is yellow or green or has a bad smell.
• Cough out fresh red blood
• Have diarrhea often.
• Feel nauseous (feel like throwing up) or you are throwing up.
• Lose weight or continue having a poor appetite.

Call 911 or go to the nearest Emergency Department if you:

• Have chest pain, tightness, or significant shortness of breath.
• Have "the worst headache of your life" that does not go away by taking pain medication.