Your Health - Thoracotomy

Thoracotomy

(Lung Surgery; Surgery, Lung)

Pronounced: THOR-uh-cot-uh-mee

Definition

A thoracotomy is a surgery to open the chest wall. The surgery allows access to the lungs, throat, aorta, heart, and diaphragm. Depending on the disease location, a thoracotomy may be done on the right or left side of the chest. Sometimes, a small thoracotomy can be done in the front part 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 trachea (wind-pipe) disorders
Remove a portion of the lung or the entire lung
Treat esophagus (throat) disorders
Reinflate lung tissue that has collapsed due to disease or trauma
Remove pus from the chest
Remove blood clots from the chest

Possible Complications

If you are planning to have a thoracotomy, your doctor will review a list of possible complications, which may include:

Bleeding
Infection
Damage to the organs in the chest
Persistent pain (only in a few cases)
Reaction to anesthesia
Collection of air or gases in the chest

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
Chronic medical problems

What to Expect

Prior to Procedure

Your doctor may perform:

Physical exam
Blood and urine tests
X-ray , CT scan , or MRI scan of the chest
Pulmonary function tests to see how well your lungs work
Heart function tests

Leading up to surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
You may be asked to use an enema to clear your guts.
Do not eat or drink anything after midnight.
To minimize complications, stop smoking at least 2-3 weeks before surgery.

Anesthesia

General anesthesia will be given. You will be asleep during the surgery.

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. Once 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.

Drainage Tubes and Incision After Thoracotomy

Immediately After Procedure

You will be sent to the intensive care unit for recovery. Your will be monitored closely.

How Long Will It Take?

3-4 hours

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. You may have some discomfort after the surgery. Your doctor will give you medicine to help you manage the pain.

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 diminishes 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

You will have IV lines and tubes in and around your body. Most of these will be removed as you recover. Some will help you urinate, breath, and get nutrition.
You may be given antibiotics, pain medicine, or antinausea drugs.
Do coughing and deep breathing exercises. Do them often 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.

At Home

When you return home, do the following to help ensure a smooth recovery:

Stay well-hydrated. Drink plenty of fluids.
Do not smoke.
Avoid environments that expose you to germs, smoke, or chemical irritants.
Be sure to follow your doctor’s instructions .

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

Difficulty breathing or cough
New pain in the chest or persistent and severe pain in the area of surgery
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
Severe nausea or vomiting
Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine

In case of an emergency, call 911 .

RESOURCES:

American Thoracic Society
http://www.thoracic.org/

The Society of Thoracic Surgeons
http://www.sts.org/

CANADIAN RESOURCES:

Canadian Society for Vascular Surgery
http://csvs.vascularweb.org/

The Lung Association
http://www.lung.ca/

References:

Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg . 2007;31:496-500.

Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J . 2008 Nov-Dec; 14(6):401-9.

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.

Wildgaard K, Ravn J, Kehlet H.Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg . 2009 Jul;36(1):170-80. Review.

Last reviewed July 2010 by Marcin Chwistek, 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.