Definition

A thoracotomy is a surgery to open the chest wall. The surgery allows access to the lungs, esophagus, trachea, aorta, heart, and diaphragm. Depending on the disease location, a thoracotomy may be done on the right or left chest. Sometimes, a small thoracotomy can be done in the front part of the chest.

Parts of the Body Involved

• Chest
• Lungs
• Back

Reasons for Procedure

• Confirm diagnosis of a lung or chest disease
• Repair the heart or the vessels of the lung and heart
• Treat emphysema complications
• Treat trachea disorders
• Remove a portion of the lung or the entire lung to treat lung cancer
• Treat esophagus disorders
• Reinflate lung tissue that has collapsed due to disease or trauma
• Remove pus from the chest (empyema)
• Remove blood clots from the chest (hemothorax)

Risk Factors for Complications During the Procedure

• Major trauma involving multiple body parts
• Age
• Heavy smoker
• Previous stroke
• Severe chronic lung disease
• Prior radiation therapy
• Underlying chronic medical problems:
  • Heart disease
  • Uncontrolled diabetes
  • Renal failure
  • HIV
  • Immunodeficiencies

What to Expect

The days leading up to your surgery:

• Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.

The day before and the day of surgery:

• Use an enema to clear your colon.
• Do not eat or drink anything after midnight.
• Your doctor may recommend a sleeping pill, so that you'll get enough rest the night before surgery.
• Before going to the hospital, remove all jewelry, contact lenses, dentures, wigs, and nail polish.

To minimize complications, stop smoking at least 2-3 weeks before surgery.

Description of the Procedure

You will be placed on your side with your arm elevated. The surgeon makes an incision between two ribs from front to back. The chest wall is opened. The surgeon removes the tissue and/or tumor from the lungs. She may work with other structures in the chest too. The surgeon will place one or more catheters (chest tubes) to make sure that your lungs stay inflated and that blood or air does not collect in the chest.

Main approaches to a thoracotomy:

Median Sternotomy

This approach involves the surgeon making a vertical incision along the sternum. She divides the sternum to gain access to the heart and lungs. Most open-heart surgeries use this procedure.

Posterolateral Thoracotomy

This is the traditional approach for lung surgery. An incision is made in the bed of the 5th rib (5th intercostals space). This lets the surgeon access the pulmonary artery and pulmonary vein.

Anterolateral Thoracotomy

A large incision is made on the anterior chest wall. This approach may be used after cardiac arrest to do an open chest massage.

Video-Assisted Thoracic Surgery (VATS)

VATS is less invasive than open procedures. The surgeon can perform VATS in select cases. She is also able to diagnose and observe from within the chest cavity (avoiding a large incision and less pain after the surgery).

Drainage Tubes and Incision After Thoracotomy

© 2009 Nucleus Medical Art, Inc.

Outcome

The outcome will depend on the reason for the procedure.

Call Your Doctor If Any of the Following Occurs

After you leave the hospital, call your doctor if any of the following occurs:

• Difficulty breathing
• New pain in the chest
• Stitches or staples come apart
• Bandage becomes soaked with blood
• Cough up mucus that is yellow, green, or bloody
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
• Cough , shortness of breath, chest pain, or severe nausea or vomiting
• Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine