Thoracotomy: Why it's done and what to expect

During a thoracotomy (thor-uh-KOT-uh-me), a surgeon makes a cut in the chest wall, typically between the ribs. The cut placement depends on the reason for the surgery. The procedure allows the surgeon to see and reach the lungs and other chest organs.

You may have a thoracotomy with another procedure to diagnose or treat a chest condition. A thoracotomy is usually done on one side of the chest.

Yes. A thoracotomy is open chest surgery. During a thoracotomy, a surgeon makes a cut in the chest wall.

Yes. A thoracotomy is major surgery. But the thoracotomy is the cut that opens the chest. The rest of the surgery depends on the operation done through the thoracotomy.

You may need a thoracotomy when a surgeon needs to see and reach organs in the chest to diagnose or treat a condition. A thoracotomy may be done to treat:

• Lung conditions, including cancer.
• Esophageal cancer and other esophageal conditions.
• Certain serious injuries to the chest, heart or major blood vessels.
• Certain diaphragm conditions.

Each type of thoracotomy refers to where and how the chest wall is cut during surgery. Different thoracotomies allow access to different parts of the chest.

• Limited anterior or lateral thoracotomy. The surgeon cuts between the ribs on the front or side of the chest wall. This allows access to organs at the front of the chest.
• Posterolateral thoracotomy. The surgeon cuts between the ribs on one side of the chest wall, near the back. This allows access to the chest lining, the entire lung, the area where major vessels and airways enter the lung, and the center of the chest.
• Bilateral anterolateral thoracotomy. The surgeon makes cuts between the ribs on both sides of the chest.

During a muscle-sparing thoracotomy, the surgeon avoids cutting certain muscles in the chest wall.

In a clamshell thoracotomy, the surgeon cuts across the sternum, also called the breastbone, to open both sides of the chest. This allows access to the heart, lungs and center of the chest. This type of thoracotomy may be used during emergency surgery. It differs from a planned thoracotomy used as part of lung surgery or cancer treatment.

A thoracotomy is done under general anesthesia. With general anesthesia, you get medicine that allows you to sleep so you aren't aware of the surgery.You may have a thin, flexible tube placed in your back to give you pain medicine.

Once you are asleep, your care team places a breathing tube in your airway and connects it to a ventilator to help you breathe during the surgery. Your surgeon may use special equipment to collapse one lung for a short time during surgery. This allows the surgeon to see and work in your chest.

The location of the chest cut depends on the reason for your surgery. Your care team may place one or more tubes to drain extra fluid or air from your chest. The tubes stay in place for a few days.

Afterward, your surgeon brings your ribs back together and closes the cut.

During a thoracotomy, a surgeon makes a cut in the chest wall. A thoracostomy is a procedure that creates an opening in the space around a lung. This space is called the pleural space. The opening allows the surgeon to use a tube or catheter to drain air or fluid. The cut for a tube thoracostomy is typically much smaller than the cut for a thoracotomy.

A thoracotomy is open surgery that uses a larger cut in the chest wall. Video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracic surgery (RATS) are minimally invasive techniques that use smaller cuts in the chest. During VATS, a surgeon uses a small camera called a thoracoscope to see inside the chest. During RATS, the surgeon controls robotic instruments and a camera to do the surgery.

For lung cancer surgery, VATS and RATS may result in a shorter hospital stay and lower the risk of some complications compared with thoracotomy.

During a thoracotomy, a surgeon typically cuts the chest wall between the ribs. A sternotomy is a procedure that divides the sternum, also called the breastbone. This allows access to the center of the chest.

Recovery depends on the type of thoracotomy and the procedure done through it. After lung surgery through a thoracotomy, recovery may take six weeks to three months. Your care team can explain how to care for your incisions and tell you about any activity limits.

During your recovery, you may use an incentive spirometer for breathing exercises to help prevent pneumonia.

Your care team may advise several methods to control pain. They may include acetaminophen, a nonsteroidal anti-inflammatory drug (NSAID) or a regional nerve block.

Post-thoracotomy pain syndrome (PTPS) is pain around the surgical wound that lasts or returns more than two months after chest surgery. It can include aching, burning or other symptoms related to nerve injury. Damage to nerves between the ribs often plays a role. PTPS doesn't happen to most people after a thoracotomy, but it's a known complication.

Complications after a thoracotomy depend on your condition and any other procedure being done through the thoracotomy. Possible complications include bleeding, infection and a reaction to anesthesia.

After chest surgery that involves a thoracotomy, complications may include pneumonia, fluid buildup around a lung, known as pleural effusion or collapse of part of a lung, called atelectasis. An irregular and often very rapid heart rhythm called atrial fibrillation also may happen.

An emergency or resuscitative thoracotomy is a procedure that may be done when someone has life-threatening traumatic injuries. This procedure differs from a planned thoracotomy for cancer treatment.

A thoracotomy with decortication is a procedure to remove thick tissue that prevents a lung from expanding. After the thoracotomy, the surgeon strips away the tissue. This allows the lung to expand more fully.