A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. There are two types of pneumonectomy, simple and extra pleural. A simple pneumonectomy removes just the lung. An extra pleural pneumonectomy take away part of the diaphragm, the parietal pleura, and the pericardium on that side as well. Indications The most common reason for a pneumonectomy is to remove tumourous tissue arising from lung cancer. Other reasons can arise are a traumatic lung injury, bronchiectasis, tuberculosis, a congenital defect, and fungal infections. Contraindications Tests The operation will reduce the respiratory capacity of the patient and before conducting a pneumonectomy, survivability after the removal has to be assessed. If at all possible, a pulmonary function test (PFT) should be done prior. It has been found that forced expiratory volume in one second (FEV1) and diffusion capacity of the lungs (DLCO) provides the best indicator of survival. Other tools can be used to assess effectiveness as well such as cardiopulmonary exercise testing to measure maximal oxygen consumption (Vo(2) max), stair climbing, shuttle walk test, and a 6-min walk test Pathologies If someone has severe valvular disease, severe pulmonary hypertension, or poor ventricular function or if cancer has spread from the lungs into the other intra-abdominal structures, ribs, or contralateral hemithorax, it is contraindicated. Surgical Approach Posterolateral thoracotomy using the fourth or fifth intercostal space is the most common approach used for pneumonectomy. In case of inflammatory and infectious indications, excision of the fifth rib may be necessary to achieve adequate surgical exposure if there is rib crowding. Video-assisted thoracoscopic surgery (VATS) approach: VATS pneumonectomy is a safe and feasible treatment for advanced malignant and benign diseases and has lower morbidity. Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With a sound technique most procedures can be completed robotically without any major complications. Anatomical Changes After a pneumonectomy is performed changes in the thoracic cavity occur to compensate for the altered anatomy. The remaining lung hyperinflates as well as shifting over along with the heart towards the now empty space. This space is full of air initially after surgery, but then it is absorbed and fluid eventually takes its place. History Pioneering dates 1895: first pneumonectomy