Thoracotomy

What is a thoracotomy?

A thoracotomy is the surgical opening of your chest cavity. It is a major surgery that allows your surgeon to access your throat, lungs, heart, aorta and diaphragm. Generally, a thoracotomy incision is located on the side of your chest. However, the exact location of a thoracotomy will depend on the disease, disorder or condition that your surgeon is treating.

A thoracotomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available depending on your specific circumstances. You should consider getting a second opinion about all your treatment choices before having a thoracotomy.

Types of thoracotomy

The types of thoracotomy procedures include:

• Limited anterior or lateral thoracotomy is an incision between your ribs on the front or side of your chest. It is a smaller incision and allows access to the structures and organs in the front of your chest cavity.
• Posterolateral thoracotomy is an incision across the side and around the back of your chest. It is a larger incision that allows access to more of your chest, including an entire lung.
• Sternal splitting thoracotomy is an incision down the front of your chest and through your sternum (breastbone). It allows access to your entire chest, including both lungs.

Other procedures that may be performed

In addition to a thoracotomy, your doctor may also perform one or more other procedures. These include:

• Decortication to remove a membrane or a fibrous covering of an organ
• Esophagectomy to remove all or part of the esophagus
• Lobectomy, the removal of one or more lobes of the lungs
• Lung or heart transplant, the replacement of either your heart or lung with a donor organ
• Open heart surgery, in which the surgeon cuts open the chest for surgery on the heart
• Pneumonectomy, the removal of an entire lung
• Tissue biopsy, to remove a cell or tissue sample and test it for cancer and other diseases
• Tumor removal
• Wedge resection, to remove part of a lobe of a lung

Why is a thoracotomy performed?

A thoracotomy is a major surgical procedure that your doctor may recommend to treat a variety of diseases, disorders and conditions of the chest. Your doctor may only consider a thoracotomy for you if other treatment options with less risk of complications have failed. Talk with your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a thoracotomy for:

• Atelectasis, the permanent collapse of lung tissue
• Benign (non-cancerous) tumors or cysts
• Confirmation of a diagnosis, such as for lung disease
• Diaphragm disorders
• Diseased or damaged blood vessels of the heart or lungs
• Empyema, or infection in the chest cavity
• Heart disease
• Hemothorax, or blood in the lungs
• Lung damage caused by emphysema or bronchietasis
• Pleurodesis, a procedure to treat a buildup of fluid in the chest cavity
• Pneumothorax, or injuries that cause the collapse of lung tissue
• Pulmonary embolism, or a blood clot in the lungs or pulmonary artery
• Severe and very specific types of chest injury or trauma, such as certain types of stabbings or gunshot wounds
• Some types of cancer including lung cancer
• Trachea (windpipe) or esophageal (swallowing tube) conditions

How is a thoracotomy performed?             

A thoracic surgeon will lead the surgical team and perform your thoracotomy in a hospital. A thoracic surgeon is a surgeon who specializes in surgical treatment of diseases of the heart, lungs, esophagus, and other structures in the chest. Rarely, an emergency medicine physician may perform an emergency thoracotomy for specific types of chest trauma.

A thoracotomy is an open surgical procedure. Your surgeon performs a thoracotomy by making a large (eight to 10 inch) incision in your chest. An open surgery incision allows your doctor to directly view and access the surgical area. Open surgery requires a large incision and involves significant cutting and displacement of muscle and other tissues.