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by Chwistek M

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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • 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:
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
Before your procedure, you may need to:
  • Use an enema to clear your digestive tract
  • Not eat or drink anything after midnight
  • Stop smoking at least 2-3 weeks before surgery to reduce the risk of complications

Anesthesia

General anesthesia will be given—you will be asleep during the procedure

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.
Incision and Drainage Tubes
thoracic drains
Copyright © Nucleus Medical Media, Inc.

Immediately After Procedure

You will be closely monitored in the intensive care unit.

How Long Will It Take?

3-4 hours or longer

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
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
During your recovery:
  • 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 heal.
  • You may be given antibiotics, pain medication, or anti-nausea drugs.
  • You may need to cough and do deep breathing exercises to keep your lungs clear. This may require the use of an incentive spirometer.
  • Get out of bed often and sit in a chair. Slowly increase your activity as tolerated.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
If you smoke, talk to your doctor about how to successfully quit. You may need to avoid places that expose you to smoke, germs, or chemical irritants. Follow instructions on wound care to prevent infection. Your doctor may advise medications to ease discomfort.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • 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
If you think you have an emergency, call for medical help right away.

RESOURCES

American Thoracic Society
http://patients.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, et al. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg. 2007;31:496-500.
Levy MH, Chwistek M, et al. Management of chronic pain in cancer survivors. Cancer J. 2008;14(6):401-409.
Ohbuchi T, Morikawa T, et al. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg. 1998;46(6):519-522.
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, et al.Chronic post-thoracotomy pain: A critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170-180.

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