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HomeAnswersFamily PhysicianatelectasisIs there any safe surgical method for ovarian cyst for a patient with mild pulmonary dilatation?

Is it dangerous to undergo laparoscopic surgery for ovarian cyst with mild pulmonary dilatation?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At December 21, 2020
Reviewed AtDecember 21, 2020

Patient's Query

Hi doctor,

My partner was due to have a laparoscopy of an ovarian cyst today. However, she saw a pulmonologist yesterday morning because she tested positive for COVID-19 the previous day. The pulmonologist did some scans and found mild dilatation of the pulmonary cone.

He told her that she could no longer have the laparoscopy of ovarian cyst because of this. And did not provide her with any alternatives. He said that her lungs would not be able to cope with the anesthesia. Her other doctor, who was due to perform the laparoscopy, had previously said that the ovarian cyst is very bad and needs urgent removal.

Please could you review the two attached letters from the pulmonologist and the scan report? She has no respiratory symptoms such as cough, chest pain, or breathing difficulty. We would like to know your thoughts on what the pulmonologist has said. Do you agree that it would not be safe to perform the operation? If so, what alternatives can you recommend? Is there anything to be done to fix the lungs? Please help.

Hi,

Welcome to icliniq.com.

I can understand your concern. According to your statement, your partner has been suffering from ovarian cyst pain for the last two to three weeks. Laparoscopic surgery of ovarian cyst was postponed due to her pulmonologist findings of mild dilatation of the pulmonary cone on her HRCT of chest, according to your description. She was COVID-19 positive.

According to her, HRCT (high resolution computed tomography) of the chest has revealed that baseline fibroatelectatic changes bilaterally. And small pneumatocele in the right segments 6 and 8.

Well, atelectatic changes bilaterally have been found on her HRCT of the chest. Atelectasis is a complete or partial collapse of the area or lobe of the lung. It occurs when the tiny air sacs or alveoli within the lung become deflated or possibly filled with alveolar fluid.

Risk factors for atelectasis are anesthesia during the operation, mucus that plugs the airway, underlying lung diseases, etc. Atelectasis can be aggravated, which is the most common life-threatening breathing or respiratory after surgery. Atelectasis is sometimes asymptomatic and shows no clinical features like cough, breathing difficulties, etc. It usually gets better with time or treatment. But it is undiagnosed or untreated, and then serious complications may occur like pneumonia, respiratory failure, etc.

Again, pneumatocele has been found on her lung. They are thin-walled, air-filled cysts or emphysematous lesions which develop on the lung. They may have resulted as a consequence of pneumonia, hematoma, lung injury, pulmonary trauma, COPD (chronic obstructive lung disease), etc.

According to your partner's HRCT of the chest, it is obvious that she needs treatment for her lung's findings as well as rest. Any type of surgery may aggravate her asymptomatic atelectasis and pneumatocele and cause severe respiratory distress, respiratory failure, etc. For that reason, her pulmonologist has advised her not to undergo surgery.

Patient's Query

Thank you doctor,

Is this lung condition treatable? What are the treatment options, and what is the predicted time scale before she could have the surgery? Also, would it be possible to have the operation now with a different form of anesthesia? For example, spinal or something? Is there any other way to do the surgery now, which would be safe?

Hi,

Welcome back to icliniq.com.

Yes, her lung condition is treatable. Treating atelectasis depends on the underlying cause and how severe her symptoms are. If she has been suffering from a cough, she can take bronchodilators like Salbutamol with or without antibiotics like Azithromycin. Otherwise, no treatment is needed without chest physiotherapy or breathing exercises.

Breathing exercise may be performed using an incentive spirometer that forces her to breathe in deeply and help open up the alveoli or blow the balloons with air. She can consult with a chest physiotherapist for physiotherapy that will help loosen and drain mucus. It is difficult to predict the duration of time when she will fit for surgery. It may take a few days to months, depending on the causes. An MRI (magnetic resonance imaging) chest or bronchoscopy can be done to exclude the causes.

General anesthesia is a common cause of atelectasis. Nearly everyone who has major surgery develops some amount of atelectasis. If your partner is scheduled for surgery, talk to her doctor about strategies to reduce her risks. Certain breathing exercises and muscle training may lower the risk of atelectasis after surgeries.

During induction of anesthesia, the application of PEEP of 6 cm H2O can prevent atelectasis and increase the margin of safety before intubation.

Again, epidural anesthesia causes no or little atelectasis and no change in shunting, ventilation/ perfusion ratio. As your partner has not presented signs and symptoms of atelectasis, discuss with her surgeon and anesthesiologist along with her HRCT of chest report. They will find a way to operate her ovarian cyst. They can also advise doing some more investigations like pulmonary function test, ABG (arterial blood gas) analysis, oxygen saturation rate by a pulse oximeter, MRI chest or bronchoscopy, etc. After examining the reports of these investigations, they will fix the probable date for the operation.

Patient's Query

Hi Dr. Zubayeralam, Thank you very much for all of your help. I have one one more question if I may please. Zorelys also is due to have an operation for umbilical hernia at the same time as having the operation for the ovarian cyst. The doctor has advised her that she will bin in surgery for up to 2 hours. Does this effect your opinion? Do you still think that she is healthy enough for the operation? That her lungs are healthy enough for the 2 hour operation in total? Also, Can you advise any treatment that she can begin immediately to commence healing the lungs? I have read online that breathing exercises etc are very helpful. Can you advise on what we can do in the immediated term to help her lungs please? Also, would you be able to write a letter for us to show her Pulmonologist. A letter that details your findings and opinions please. I will pay the extra fee for such a request.
hi thnx for joining again. yes, ovarian cyst and umbilical hernia can be operated in the same operation. I have already mentioned that some investigations will be needed for assessing her present lung status like pulmonary function test, ABG analysis, oxygen saturation rate, MRI of Chest or Bronchoscopy etc. After assessing her current lung status, it can be finalized the possibility of operation. it will take two hours and that is normal for two operations. well , decision of operation will be depended on both the surgeon and the anesthesiologist as, I have mentioned earlier that u can consult with the surgeon and anesthesiologist with her radiological reports. according to ur description, she has no symptoms of cough, shortness of breath etc. surgery may aggravate her atelectasis which is the only problems. Bronchodilators like salbutamol, oral or injectable steroid may be used before her surgery if her pulmonologist or anesthesiologist wants and after surgery those medications if needed or breathing exercises can help her recovery. epidural anesthesia can be used during anesthesia,if there is no contraindication. after assessing ur girlfriend, her pulmonologist advised what medications or measures should be taken to undergo for a operation? it is his duty to advise or prescribe his patients for their future betterment. well, I don't know how can I contact with her pulmonologist.as I haven't examined ur girlfriend physically, so my opinion regarding her may not be accepted. but I want to help u.it is not for money or something like that. ur love for her is just amazing. hats off, man. in case of any other query ask me.

Patient's Query

Thank you very much, your help is greatly appreciated. 'but I want to help u.it is not for money or something like that. ur love for her is just amazing. hats off, man.' Thank you, I really appreciate this. Her current Pulmonologist in Dominican Republic has stopped the operation and said that she could die if they were to operate on her because of her lung condition and the anesthetic. He has not advised any further. He wants to carry out more tests on the lungs but has said that it might be many months before they can do anything for her. He has simply said that he will not take the responsibility for giving the permitting the operation but has not povided us with alternatives or advice. She is currently in great pain and is not eating very much at all. I am very worried about the prospect of waiting for many months. Her mood is very very bad and I am very worried about her state of mind and the potential for depression. She is very sad and upset. In relation to the letter I referred to. I was wondering if you could write a short letter, simplt detailing your advice as to how to proceed. For example your opinion on the best way to move forward now. For example having the operation with the spinal epidural anesthetic. Or precautions etc for the operation. I would like to print off a letter with your advice and findings and bring it to her Pulmonologist in Dominican Republic. Do you think this would be possible. I really appreciate all of your help Doctor. Thank you
if ur girlfriend has no symptoms at present, then how can her lung condition becomes critical at present? her atelectasis has found accidentally on her radiological test. ovarian cyst becomes larger and may rupture.ruptured cyst can cause heavy bleeding or Infections that may become a life threatening condition. then who will be responsible? please, provide me the gmail address of her pulmonologist. I will send her pulmonologist email regarding my opinion and ur patient's present sufferings. zubayeralam48@gmail.com......it is my Gmail account.

Patient's Query

Thank you so very very much Dr. You do not understand how much I appreciate this. I will get it for you as soon as I possibly can. They might be closed today though, it might be tomorrow. But I will do it as quickly as I can. Thank you again, you are a great person.
no,no it doesn't matter. I m a chosen one by the almighty, so I have to help people.just send me the pulmonologist's Email address. I will convey him my opinion and try to request him for reconsidering her case. ur girlfriend may visit another pulmonologist and consult with him again about her radiological findings.

Patient's Query

' m a chosen one by the almighty' I believe so!!!! Thank you again Doctor. I have just remembered that this morning, I booked an online consultation with yourself through docaid. I thought it might be necessary. But you have been great. Please do not worry about this appointment.... treat yourself to a break and a coffee during it! Thanks again doctor, I will be in touch as soon as I can get the email address
thank u. I will be happy if I can help u.

Patient's Query

Hi Dr Zubayeralam, I just wanted to give you a quick update. I collected our correspondence and translated it for my girlfriend to show her Pulmonologist in Dominican Republic, and she was goinf to ask for his email address also so that I could send it to you ( like you very kindly offered). And she got on very well with him. He listened to what you had said, and consulted with another colleague in his hospital and he agrees. He gave her some kind of medication for her lungs and referred her for physio. And now she is going to have the operation on Tuesday. I wanted to thank you from the bottom of my heart for all of your help, it was very much appreciated. I genuinely wrote this message to you solely to thank you, but now that I am writing, I would like to ask one final thing of you if I may. My girlfriend is still feeling quite sad and down about the whole thing. And she is not very inspired to do the breathing exercises. She does not understand how simple breathing exercises could help and she thinks it is just silly! Would you be able to give a brief description of why the breathing exercises are very beneficial for me to show her. How it helps to heal her lungs. She really appreciated all of your help also, and I think she would believe it if you were to say it to her. Thank you again, And happy new year Adrian
hi, thank u for joining again. honestly I am waiting for your reply. waiting for the pulmonologist's Email address.because I have to keep my words. thank you so much to the almighty that the operation will be held on soon. thank you both u and ur girlfriend, because both of u r highly educated. both of u was able to understand my medical explanation as well as even convince the pulmonologist and the surgeon. hats off both of u for ur wisdoms and knowledge.it is almost impossible to convince a doctor to change his or her treatment plan. but both of u did it possible. I did nothing, just sharing my few knowledges with u. nothing else. Happy new year both of u,too.keep continuing ur love story. ok, let's go to the matter. well, she mayn't need to do any breathing exercise after surgery. but for her safety, as a precaution, she can try to do practice some breathing exercises.breathing exercise may be performed by using an incentive spirometer that force her to breathe in deeply and help to open up the alveoli. even she can practice to blow few balloons every day. such type of breathing exercises may help to expand her chest and improve her lung capacity as well as prevent the lungs from collapse or developing atelectasis. u can check the following websites in google and youtube about INCENTIVE SPIROMETER- www.healthline.com > health > incentive spirometer: what it's for and how to use it my.clevelandclinic.org/health/articles/4302-incentive-spirometer/how to use an incentive spirometer medlineplus.gov/ency/patientinstructions/000451.htm/ using an incentive spirometer www.webmed.com/lung/lung-incentive-spirometer/how it helps you breathe www.physio-pedia.com/Incentive_Spirometry How to Use an Incentive Spirometer-Nemours KidsHealth-YouTube from the above mentioned websites and many more, u can understand its benefits of using. she can blow few balloons every day and I think that is enough for her. take care.happy new year,both of u again.let me know if I can assist you further.

Patient's Query

Thank you so very much again Dr, all the best. And happy new year
hi thnx for joining again. thank you so very much too. have a safe operation. take care. and happy new year.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muhammad Zubayer Alam
Dr. Muhammad Zubayer Alam

Pulmonology (Asthma Doctors)

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