Sometimes it is difficult to diagnose the type of lung disease from tests. You may be referred for a biopsy to get a diagnosis and plan the best treatment.
What is a surgical lung biopsy?
A surgical lung biopsy is an operation which is used to get samples of lung tissue. This is done to diagnose types of lung disease, it does not help symptoms of the lung disease. The operation is done with you asleep under a general anaesthetic. It is a bigger procedure than needle biopsies, you will need to allow time for recovery.
It is usually a keyhole (VATS) operation and takes about 1 hour. During surgery you lie on your side with your arm raised. Up to 4 small cuts are made, each about 5cm (2 in) long. These are used for the instruments and small camera to go into the chest. Special staples are used to cut and seal parts of lung that need to be removed for testing. The pieces of lung can be removed through one of the small cuts. The wound is closed with dissolvable stitches. 1 or 2 chest drains are put in at the end of the operation and held in placed with a stitch. These remove any fluid or air from around the lung.
If there is a problem during the operation a bigger cut may be needed (thoracotomy). This cut is one larger incision under the shoulder blade, the incision goes between 2 ribs. The 2 ribs are parted to get into the chest. One rib may be cut to give more space, ribs are not removed. At the end of surgery the 2 ribs are held back together with strong stitches. The muscles and skin are also stitched back together.
The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried.
of thoracic surgery apply to surgical lung biopsy.
In addition the following are risks of surgical lung biopsy:
- Minor more common risks
Air leaking from the lung into the chest drain for a few days is common after lung surgery. Occasionally this lasts for longer, possibly weeks. A chest drain will need to be in place until this settles, you may be able to go home with the chest drain still in and come back for regular check-ups until the air leak settles.
Your kidneys may not work as well after surgery but this is usually temporary and gets better with extra fluid.
- Major less common risks
You may experience a flare up of your breathing symptoms after surgery. This could be a slight change or may cause severe breathlessness. Shortness of breath may severe enough to require help from a ventilator machine. This can be with a face mask with you fully awake. It may also be need via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves. The risk of death from a surgical lung biopsy is 1 in 100 nationally, this also means 99 in 100 people recovery from surgery.
Having a diagnosis can guide which treatments would be best for you. It can also give you an idea of what to expect from the disease, including symptoms or whether the disease may shorten your life.
If you do not want to have an operation to get a diagnosis other options may include:
- Relying on existing tests (such as scans) to judge which disease is most likely
- Repeating a previous test
- Continuing close observation
It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.