(Lung Surgery; Surgery, Lung)
Pronounced: THOR-uh-cot-uh-meeEn Español (Spanish Version)
A thoracotomy is a surgery to open the chest wall. The surgery allows access to the lungs, esophagus, trachea, aorta, heart, and diaphragm. Depending on the disease location, a thoracotomy may be done on the right or left chest. Sometimes, a small thoracotomy can be done in the front part of the chest.
Reasons for Procedure
- Confirm diagnosis of a lung or chest disease
- Repair the heart or the vessels of the lung and heart
- Treat emphysema complications
- Treat trachea disorders
- Remove a portion of the lung or the entire lung to treat lung cancer
- Treat esophagus disorders
- Reinflate lung tissue that has collapsed due to disease or trauma
- Remove pus from the chest (empyema)
- Remove blood clots from the chest (hemothorax)
Risk Factors for Complications During the Procedure
What to Expect
Prior to Procedure
- Physical exam
- Blood and urine tests
- X-ray, CT scan, or MRI scan of the chest
- Pulmonary function tests to check lung capacity to undergo surgery
- Heart test to make sure that you can withstand surgery
- Blood test to see if you are getting enough oxygen and are excreting carbon dioxide
- Undergo pulmonary rehabilitation to exercise your lungs
The day before and the day of surgery:
- Use an enema to clear your colon.
- Do not eat or drink anything after midnight.
- Your doctor may recommend a sleeping pill, so that you'll get enough rest the night before surgery.
- Before going to the hospital, remove all jewelry, contact lenses, dentures, wigs, and nail polish.
To minimize complications, stop smoking at least 2-3 weeks before surgery.
Description of the Procedure
You will be placed on your side with your arm elevated. The surgeon makes an incision between two ribs from front to back. The chest wall is opened. The surgeon removes the tissue and/or tumor from the lungs. She may work with other structures in the chest too. The surgeon will place one or more catheters (chest tubes) to make sure that your lungs stay inflated and that blood or air does not collect in the chest.
Main approaches to a thoracotomy:
This approach involves the surgeon making a vertical incision along the sternum. She divides the sternum to gain access to the heart and lungs. Most open-heart surgeries use this procedure.
This is the traditional approach for lung surgery. An incision is made in the bed of the 5th rib (5th intercostals space). This lets the surgeon access the pulmonary artery and pulmonary vein.
A large incision is made on the anterior chest wall. This approach may be used after cardiac arrest to do an open chest massage.
Video-Assisted Thoracic Surgery (VATS)
VATS is less invasive than open procedures. The surgeon can perform VATS in select cases. She is also able to diagnose and observe from within the chest cavity (avoiding a large incision and less pain after the surgery).
Drainage Tubes and Incision After Thoracotomy
© 2008 Nucleus Medical Art, Inc.
The incision is closed with stitches or staples, and bandaged to prevent infection. You will be sent to the intensive care unit for recovery. After surgery, you will have intravenous lines and tubes in and around your body. Most of these will be removed as you improve and eat and walk. You will have several catheters. These catheters will help you with different bodily functions such as urinating and breathing. You may be given antibiotics, pain medication, or antinausea drugs.
How Long Will It Take?
Will It Hurt?
Anesthesia prevents pain during the procedure. You may have some discomfort after the surgery.
- Bleeding in the lung cavity (hemothorax)
- Infection on the skin wound
- Infection inside the chest cavity
- Persistent pain (only in a few cases)
- Reaction to anesthesia
- Failure to completely expand the lung
- Continued drainage from the chest tubes
- Collection of air or gases in the lung cavity (pneumothorax)
Average Hospital Stay
- Do coughing and deep breathing exercises as taught by the nurse or physical therapist. Do them 3-4 times daily 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.
- Stay well-hydrated.
- Do not smoke.
- Avoid environments that expose you to germs, smoke, or chemical irritants.
Call Your Doctor If Any of the Following Occurs
After you leave the hospital, call your doctor if any of the following occurs:
- Difficulty breathing
- New pain in the chest
- Stitches or staples come apart
- Bandage becomes soaked with blood
- Cough 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
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
American Thoracic Society
The Society of Thoracic Surgeons
Canadian Society for Vascular Surgery
The Lung Association
Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg. 2007;31:496-500.
Medical encyclopedia: lung surgery. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002956.htm. Accessed October 14, 2005.
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.
Saint Mary's Hospital, Saginaw website. Available at: http://www.hospitalsoup.com/rn/asp/HospitalID.11842/pt/hospitaldetails3.asp. Accessed October 14, 2005.
University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/videoassistedthoracoscopicsurgery.html. Accessed June 15, 2007.
Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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