Page 52 - AlertDiver_Winter2013

Q:I just had lung surgery.
When can I safely go back
to diving?
A:Lung surgery is done to get a
better look at a patient’s lung
tissues, often to diagnose,
biopsy, repair and/or remove an
underlying condition. There are
myriad lung conditions that require
surgery. Lung cancer, for example,
may require surgical removal of the
diseased tissue via the chest wall.
The surgical approach or technique
used will depend on various factors,
but it will consist of either an
open procedure or video-assisted
thoracoscopic surgery (VATS). In an
open procedure, the lung is reached
through an incision known as a
thoracotomy, which allows for direct
visualization of the lung. In VATS, the
lung is observed using a camera and
a series of small incisions, as in laparoscopic procedures
(minimally invasive abdominal surgery). Both VATS and
thoracotomy allow a surgeon to visually inspect, remove
and/or repair tissue. Lung surgery may also be conducted
because of severe emphysema, trauma, severe infection
of the lungs (tuberculosis, bronchiectasis, etc.), infection
of the membranes that line the lungs (empyema), cystic
fibrosis, massive bleeding and many other reasons.
Following surgery, divers must be sure the lung
has completely healed; a persistent broncho-pleural
fistula (communication between the lung and the space
surrounding it) could be life-threatening during a dive,
particularly during ascent. Lung surgery is subject to a
variety of potential complications. The primary concern
for divers is the risk of pulmonary overexpansion or
pulmonary barotrauma. One postsurgical problem that
can increase this risk is the development of adhesions or
scar tissue between the surface of the lung and the chest
wall. These may cause areas of the lung to be tethered and
more susceptible to injury or tearing during the changes
in pressure and volume that occur while diving.
After surgery, a person’s lung function (ability to move
air in and out of the lungs) changes, and this must be
evaluated prior to diving. A diver’s exercise capacity must
also be assessed to see if physical performance can be
maintained during dives. Other potential problems to
consider include the risk of disease recurrence, any effects
of radiation or chemotherapy, the type of diving to be
done (recreational, technical or professional, for example)
and whether the diver could survive with only the
operated lung if a dive accident caused a severe injury to
the normal lung. These concerns should all be discussed
with a pulmonologist and, ideally, a doctor with training
in dive medicine.
— Jose Evangelista, M.D.
RESEARCH, EDUCATION & MEDICINE // F R O M T H E M E D I C A L L I N E
50 | WINTER 2013
Diving After Lung Surgery
DAN® medics answer your
questions about dive medicine.
PLATINUS/ISTOCKPHOTO.COM