A thoracotomy is the surgical opening of the chest cavity. Surgeons use it to access the throat, lungs, heart, aorta and diaphragm to perform different types of thoracic surgical treatments. Generally, a thoracotomy incision is several inches long and located on the side of your chest. However, the exact location will depend on the disease, disorder or condition that your surgeon is treating. Thoracotomy recovery is more extensive than thoracoscopy, a minimally invasive technique to access the pleural space around the lungs and perform surgical procedures. Still, video-assisted thoracoscopic surgery is not appropriate in every situation and thoracotomy may be necessary. 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. Surgical procedures that may be performed with thoracotomy Other procedures your surgeon may perform with a thoracotomy 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 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 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 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. Your thoracotomy will be performed in a hospital. A thoracotomy is an open surgical procedure. It involves making a large (8 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 (4 to 6 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. Minimally invasive thoracic surgery is known as video-assisted thoracoscopic surgery, or VATS. 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. 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 clots Infection 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 Persistent pain 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 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. 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 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 Quit smoking Prevent colds and lung infections by avoiding sick people and diligently practicing hand washing during your recovery Stay hydrated 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.