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Thoracotomy

(Lung Surgery; Surgery, Lung)

Definition

A thoracotomy is a surgery to open the chest wall. The surgery allows access to the lungs, aorta, heart, diaphragm, and spine. Depending on the disease location, a thoracotomy may be done in the center or on the right or left side of the chest.

Reasons for Procedure

A thoracotomy may be done to:
  • Confirm diagnosis of a lung or chest disease
  • Repair the heart or the vessels of the lung and heart
  • Treat windpipe disorders
  • Remove a portion of the lung or the entire lung
  • Reinflate lung tissue that has collapsed due to disease or trauma
  • Remove pus from the chest
  • Remove blood clots from the chest
  • Remove tumors or lymph nodes

Possible Complications

If you are planning to have a thoracotomy, your doctor will review a list of possible complications, which may include:
  • Bleeding
  • Infection
  • Collapsed lung
  • Damage to the organs in the chest
  • Reaction to anesthesia
  • Collection of air or gases in the chest
  • Persistent pain—rare
Factors that may increase the risk of complications include:
  • Major trauma involving multiple body parts
  • Age
  • Heavy smoker
  • Previous stroke or heart attack
  • Prior radiation therapy
  • Obesity
  • Chronic medical problems

What to Expect

Prior to Procedure

Your doctor may perform:
Leading up to surgery:
Leading up to surgery:
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure such as:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners
  • You may be asked to use an enema to clear your digestive system.
  • Do not eat or drink anything after midnight.
  • To minimize complications, stop smoking at least 2-3 weeks before surgery.

Anesthesia

General anesthesia will be given. You will be asleep during the surgery.

Description of Procedure

You will be placed on your side with your arm elevated. An incision will be made between two ribs, from front to back. The chest wall will then be opened. In some cases, the doctor may take a different approach. The doctor can then do whatever procedure needs to be done in the open chest. When the procedure is done, one or more chest tubes will be placed. The tubes will make sure that blood or air does not collect in the chest. The chest wall will be closed. The incision is closed with stitches or staples and bandaged to prevent infection.
Drainage Tubes and Incision After Thoracotomy
thoracic drains
Copyright © Nucleus Medical Media, Inc.

Immediately After Procedure

You will be sent to the intensive care unit for recovery. You will be monitored closely.

How Long Will It Take?

3-4 hours or longer

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. You will have some discomfort after the surgery. Your doctor will give you medicine to help you manage the pain.
For some, a thoracotomy can lead to a chronic pain syndrome. It is usually described as burning pain in the area of surgery. It may be associated with increased sensitivity to touch in this area. It usually lessens over time, but you may need to see a pain specialist if the pain persists.

Average Hospital Stay

The usual length of stay is 5-10 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital
  • You will have IV lines and tubes in and around your body. Some of the lines and tubes will help you urinate, breath, and get nutrition. Most of the lines and tubes will be removed as you recover.
  • You may be given antibiotics, pain medicine, or anti-nausea drugs.
  • Do coughing and deep breathing exercises.You may also use an incentive spirometer to help you with this. Do them often to help keep your lungs clear.
  • Get out of bed often and sit in a chair. Increase your activity as much as you are able.
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Drink plenty of fluids.
  • Do not smoke.
  • Avoid environments that expose you to germs, smoke, or chemical irritants.
  • Ask your doctoer when it is safe to drive and return to work.
  • Be sure to follow your doctor’s instructions .

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occur:
  • Difficulty breathing or cough
  • New pain in the chest or persistent and severe pain in the area of surgery
  • Stitches or staples that come apart
  • Excessive bleeding at the site of the incision
  • Coughing 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
  • Severe nausea or vomiting
In case of an emergency, call for medical help right away.

RESOURCES

American Thoracic Society http://www.thoracic.org

The Society of Thoracic Surgeons http://www.sts.org

CANADIAN RESOURCES

Canadian Society for Vascular Surgery http://canadianvascular.ca

The Lung Association http://www.lung.ca

References

Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg . 2007;31:496-500.

Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J . 2008 Nov-Dec; 14(6):401-409.

Ohbuchi T, Morikawa T, Takeuchi E, Kato H. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg . 1998 Jun;46(6):519-22.

Video-assisted thoracoscopic surgery (VATS). University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/videoassistedthoracoscopicsurgery.html . Accessed May 22, 2013.

Wildgaard K, Ravn J, Kehlet H.Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg . 2009 Jul;36(1):170-180. Review.

Revision Information

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