Sarah Lewis, PharmD
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 serious risks and potential complications. You may have less invasive treatment options. 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 and your heart.
Other procedures that may be performed
Your doctor may perform other procedures in addition to a thoracotomy. 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
Wedge resection, to remove part of a lobe of a lung
Why is a thoracotomy performed?
Your doctor may recommend a thoracotomy 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 been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a thoracotomy.
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
Diseased or damaged blood vessels of the heart or lungs
Empyema, or infection in the chest cavity
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
Who performs a thoracotomy?
The following specialists perform a thoracotomy:
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
Trauma doctors and emergency medicine doctors specialize in emergency care of people with serious and life-threatening illnesses and injuries. Rarely, this type of doctor may perform an emergency thoracotomy for specific types of chest trauma.
How is a thoracotomy performed?
Your thoracotomy will be performed in a hospital. A thoracotomy is an open surgical procedure. It involves making a large (eight to 10 inch) incision in your chest. Open surgery incision allows your surgeon 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.
Newer techniques allow surgeons to use a smaller incision (four to six inches) in some cases. This type of procedure is sometimes called a muscle-sparing thoracotomy because the surgeon does not cut through your chest muscles. Instead, the surgeon moves the muscles out of the way or separates the muscle fibers. This is not a minimally invasive procedure, but it may provide similar advantages. This includes faster recovery times and less pain.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different thoracotomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform a thoracotomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your thoracotomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a thoracotomy?
As with all surgeries, a thoracotomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood. This includes pneumonia.
Potential complications of a thoracotomy
Complications of a thoracotomy include:
Air or gases trapped in your chest
Damage to your lungs, heart, or blood vessels
Numbness or sensitivity of the chest skin
Recurrent fluid buildup
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my thoracotomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a thoracotomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, other imaging studies, EKG (electrocardiogram), pulmonary function tests, blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may need to take a laxative or use an enema to clean out your bowel the day before surgery.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a thoracotomy? Are there any other options for treating my condition?
Which type of thoracotomy procedure will I need? What other procedures will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my thoracotomy?
Knowing what to expect can help make your road to recovery after a thoracotomy as smooth as possible.
How long will it take to recover?
Your care team may move you to an intensive care unit (ICU) to recover after surgery. ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia have worn off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain fluids from your chest and bladder, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube, but it is usually removed within 24 hours. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. The chest drains and urinary catheter will be removed several days after surgery.
You may move to a hospital room outside the ICU as you recover. This room will have the equipment to monitor your heart rhythm and vital signs. Hospital stays typically range from five to 10 days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor may refer you to a rehabilitation program to help you recover. Full recovery takes up to three months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a thoracotomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding, especially bleeding that soaks through your bandages
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Cough or coughing up yellow, green or bloody mucus
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, pas gas, or have a bowel movement
New chest pain or severe pain in your surgical site
Pain that is not controlled by your pain medication
Severe nausea or vomiting
Stitches or staples that pull apart
Unexpected drainage, pus, redness or swelling of your incision
How might a thoracotomy affect my everyday life?
A thoracotomy may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. Your prognosis depends on the reason for you surgery, your medical history, age and other factors.
A thoracotomy may also cause changes to your body that affect your everyday life, especially during recovery. These changes may require you to:
Avoid smoke, dust, particulates, chemical irritants, and other airway irritants throughout your recovery
Follow restrictions on activities and lifting throughout your recovery
Prevent colds and lung infections by avoiding sick people and diligently practicing hand washing during your recovery
Walk and use your spirometer everyday as directed during your recovery. A spirometer is a device you will use for breathing exercises. This can help prevent pneumonia.
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