Decortication 

is a medical procedure
involving the surgical removal of the
surface layer, membrane, or fibrous cover of
an organ. The procedure is usually
performed when the lung is covered by a
thick, inelastic pleural peel restricting lung
expansion. his outer lining of the lung is
called the parietal pleura, and the
decortication process in this case is known
as a pleurectomy
It is usually a palliative procedure,
meaning it simply relieves the symptoms
and is not considered a potential cure.
For patients with mesothelioma,
typically, the purpose of the procedure is
to control fluid that tends to build up
around diseased lungs, which will help
to decrease painful pressure and improve
the patient's ability to breathe
comfortably
The decortication process requires general
anesthesia, meaning that the patient is
unconscious throughout the procedure.
Depending on the condition of the patient,
chemotherapy or radiation therapy may be
administered while the cancer is exposed
during surgery. The procedure requires that
the patient stay in the hospital for several days
afterward for observation and recovery
A thoracotomy is a surgical procedure in
which the chest wall (thorax) is opened,
allowing access to the organs beneath it. A
lateral thoracotomy provides access to the
lungs, major blood vessels, and the esophagus,
and an anterior thoracotomy provides access to
the heart and coronary arteries.
Thoracotomy may be needed for lung cancer,
other tumors, tuberculosis, lung
abscesses, bronchiectasis, emphysema, collapsed
lung, gas in the lung (pneumothorax), blood in the
lungs (hemothorax), or injuries that have resulted
in collapsed lung. It is sometimes performed in
emergency situations in which traumatic injuries
and episodes have occurred in the chest and near
the heart and lungs, such as a stab or gunshot
wound. It is also often used in conjunction with
heart surgery and in the treatment of recurring
pneumothorax or hemothorax.
 For biopsy of the lung, of the outer covering of
the lung (pleura), of the site where nerves and
vessels enter or leave (hilum), and of the
central part of the thoracic cavity
(mediastinum), thoracotomy is the diagnostic
gold standard to which all other procedures
must be compared. However, other procedures
such as thoracoscopy and mediastinoscopy
have decreased the need for thoracotomy
All are done under a general anesthesia.
In anterior thoracotomy, a vertical incision is made from the
base of the neck to the lower end of the breastbone
(sternum). The sternum is divided with a saw (sternotomy)
and gently pried apart. With the heart exposed, the
necessary surgery can be performed.

In a lateral thoracotomy, an incision is made

between the ribs to allow access to the lungs. The
incision is made from back to front along the rib
line. The ribs are spread apart, and occasionally
part of a rib is removed. The lung may be biopsied
through the incision.
Following the procedure, a temporary drainage
tube is inserted into the pleural cavity (the
space between the membranes lining the chest
wall and the membranes covering the lungs).
This allows fluid to drain and permits air in the
pleural space to be removed, thereby allowing
the lung to fully expand. If the procedure
involved a sternotomy, the sternum is closed
with strong stitches or wire. The muscles and
overlying skin are closed with stitches.
 The outcome depends on the type and severity
of the problem, but many individuals recover
uneventfully. The hospital stay is usually 7 to
10 days. The chest tube remains in place until
the lung has fully expanded (typically 48 to 72
hours). Pain is managed with medications.
may result in death of the individual.
 Complications vary according to the organ or
system being examined and treated.
Complications may include reactions to
medications, breathing difficulty,
bleeding, infections, blood clots, pneumonia,
and chronic pain from damage to the nerves in
the chest. Additionally, lung collapse due to
poor post-operative re-expansion (atelectasis)
or due to a persistent opening between the
lung and the chest wall (bronchopleural fistula)
can result. There can also be complications
associated with receiving general anesthesia.
Severe cardiac problems
 The principle of nonmaleficence is considered
by some rule-deontological and rule-utilitarian
theorists to be the foundation of social
morality.  Some philosophers view
nonmaleficence and beneficence as similar and
distinct obligations of human life.  Beneficence
suggests the acts of mercy, kindness, and
charity.  It includes any form of action that
benefits another
Nonmaleficence is distinguished from and part of the
principle of beneficence by its commitment to not
inflict harm to an individual.  Beneficence involves
positive acts of preventing harm, removing harm, and
promoting good

The principle of nonmaleficence supports several moral

rules.  Rules prohibiting harmful actions are at the core
of morality - for example, "Don't kill," "Don't cause
pain," "Don't deprive of freedom of opportunity," and
"Don't deprive of pleasure
 The principle of double effect, which is a part of
the principle of nonmaleficence, provides for
the understanding that good can come out of a
bad act.
The principle of double effect has been invoked to
support claims that an act having a harmful
effect such as death does not always fall under
moral prohibitions such as the rule against
killing