Thoracotomy

Overview

During a thoracotomy, a surgical procedure involving the opening of the chest, a cut is made between the ribs to access and examine various organs such as the heart, aorta, esophagus, lungs, trachea, and potentially the front of the spine. The choice of the left or right side for the incision depends on the specific organ targeted for observation or treatment. In certain cases, the surgeon may need to break or remove a rib. The incision extends from the chest, passing under the armpit to the back, with its size and precise location tailored to the specific type of surgery being performed. This approach is commonly referred to as open surgery.

Reasons for undergoing the procedure

To conduct a biopsy and extract tissue for diagnostic purposes, a thoracotomy may be necessary, performed by a doctor. This procedure can also serve therapeutic purposes. A thoracotomy might be required for the treatment of:

• Cancer of the lung removed.
• Conditions related to the heart.
• Problems relating to your diaphragm.
• A biopsy to check for lung disease.
• Pulmonary collapse (pneumothorax).
• Cardiac tamponade (pericardial tamponade, another name for it).
• Esophageal disorders, such as cancer of the esophagus.
• Pleural effusion, also known as “water around the lungs,” particularly in the event of an infection.

Risks

Thoracotomies, like any surgical procedure, come with risks. Some of these include:

• Infection
• Bleeding
• Pain
• General anesthesia reaction

Subsequent complications might involve:

• Deep vein thrombosis, a blood clot in the leg that might obstruct the lungs (pulmonary embolism).
• Months after the procedure, discomfort that remains is known as post-thoracotomy pain syndrome.
• Your lungs has leaking air.
• Atelectasis, a lung collapse affecting one or more sections.
• Pneumonia, an infection affecting the respiratory system.

Before the procedure

Before undergoing a thoracotomy surgery, it’s essential to be in good health to receive general anesthesia, and your healthcare team will provide instructions regarding fasting prior to the procedure. Inform them about any medications, vitamins, or supplements you are taking, including over-the-counter products. Your healthcare providers will guide you on adjusting medication schedules, particularly for substances like blood thinners. In the case of nonemergency thoracotomies, quitting smoking may be strongly advised by your healthcare provider.

During the procedure

During a thoracotomy, you’ll be positioned with one arm over your head, secured in a padded holder, while the other arm and shoulder are supported by a rolled blanket. The anesthesiologist, specialized in thoracic procedures, will facilitate single lung ventilation, directing breathing to the non-operated lung. The surgeon will make an incision between specific ribs, potentially dividing or breaking one if needed. The use of a heated probe, retractors, and a rib spreader allows access to and repair of targeted organs. After closure, a chest tube is inserted to aid in fluid drainage and release of air.

After the procedure

After the thoracotomy, expect a hospital stay of approximately a week, during which the chest tube(s) will be retained for at least a few days. The healthcare team will actively encourage activities such as coughing, using the incentive spirometer, and taking assisted short walks. They will also assist in pain management. If the thoracotomy was performed for diagnostic purposes regarding a condition, your healthcare provider will communicate the findings and outline your next steps.

Outcome

After the thoracotomy procedure, resume normal eating habits but consider a daily fiber supplement to prevent constipation. Drink fluids freely unless advised otherwise. Take pain medication as directed, ensuring deep breathing to prevent pneumonia.

Expect a week in the hospital and two months off work. Follow surgical team instructions on resuming activities, including sexual relations, lifting, and sports.

At home, focus on deep breathing, coughing, and using the incentive spirometer. Follow recommended arm and shoulder exercises. Attend follow-up appointments and contact your provider for concerns such as fever, bleeding, breathing difficulties, or concerning changes to the incision.