What is Decortication of the Lungs?



Snakes have a process to shed their skin which is called Ecdysis. The process helps the Snake get a new skin while the old skin is  shed. It can renew its skin as and when the body requires. How wonderful it would be if we humans were to be blessed with such a gift. But unfortunately, we have to carry the same scarred and blemished skin throughout our lives. But then there are some organs like lungs, on which decortication  or peeling of the outer layer is performed. This has been known to the physicians since the 20th century but is a palliative treatment and not a cure.  


Why is Decortication necessary?

In general decortication is commonly associated with removal of rind or peel.  In the medical field, decortication is peeling of the outer layer of an organ owing to some disease or collapse of the outer You do not have access to view this node. This process is more widely used for treating lungs which cannot expand due to the disease. The problem is known as trapped lung , wherein  the visceral pleura is removed as the lungs have problem  in expanding and breathing freely. This is a palliative treatment commonly performed when persistent pain while breathing is complained by the patient. Mostly tuberculosis and mesothelioma(a rare form of lung cancer) patients have to undergo this You do not have access to view this node. When it is done with a curative intent, along with decortication,  parietal pleurectomy  too is performed in which apart from removal of outer tissue of the pleura, some extra pleural tissues too are peeled off with the aim that no trace of malignant cells stay back.


How is the functioning of lungs limited by mesothelioma?

Our blood is purified by lungs through contraction and expansion. When certain cells or disease form a layer over the outer side of lungs, its contraction and expansion process becomes compressed and the sufferer finds it difficult to breathe. Rather breathing becomes very painful as the layers go on increasing.  Mostly these layers are due to the presence of mesothelioma tumor cells which affect the visceral pleura. Hence the lung's elasticity is confined which create breathing problems. During decortication, this outer sheath that has been formed is removed. But doctors warn that this usually works for only short period of time and does not contribute in improving patient's prognosis.


Decortication process is a very delicate and serious surgery in which the surgeons remove several layers of pleura so as to be assured that the malignant cells are removed fully. But during the resection( refers to removal of an organ or lesion by cutting it away from the body or the rest of the tissue.) there are chances of the lungs getting damaged and hence this surgery is performed by renowned masters in the field with keen precision. After the removal of pleura, the surgeons also try to remove any pus cells or infection through resection. Thoractomy has been used since long by the doctors as it offers clear view of the pleural cavity and also enough space to the surgeons to move around their knives and scalpels.  But nowadays, VATS technique is being tried by the surgeons. Although the experiments done till now have shown more promise but more research is needed before it finally replaces Thoractomy. Also Vats decortication will be beneficial for those who cannot use Thoractomy for the purpose.


What is VATS?

VATS is a Video Assisted Thoracoscopic Surgery.  This is known to be more promising than Thoractomy and is less invasive. The inner tissue structure of pleura cells is clearly visible which assists in removing the excess fluid and pus cells. Fluid extraction for biopsy too can be done with the help of VATS. In case of involvement of lymph node it can  be used for lymph node resection. In the surgical world, recent research  in VATS has been known to bring  improvements in palliative use of pleurectomy and decortication

Since this You do not have access to view this node is very delicate and intensive one and though  the mortality rates over the years have been generally low, decortication  should be considered only if the palliative option is worth trying.

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During decortication, this outer sheath that has been formed is removed.!
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