It is a surgery that consists of opening the patient’s chest.
During this procedure, a surgeon makes an incision in the chest wall between the ribs, usually to operate on the lungs. The surgeon can remove part or all of a lung through this incision.
The thoracotomy is often performed to treat lung cancer. It is sometimes used to treat heart problems or other structures in the chest, such as the diaphragm.
A thoracotomy can also be used to help diagnose a disease. For example, you can allow a surgeon to remove a piece of tissue for a deeper examination (biopsy).
Thoracotomy vs. Thoracostomy
Although thoracotomy and thoracostomy sound almost the same, the terms describe two very different procedures:
Thoracotomy: Thoracotomy is a surgery that makes an incision to access the chest. It is often done to remove part or all of a lung in people with lung cancer.
Thoracostomy: Thoracostomy is a procedure that places a tube in the space between the lungs and the wall of the chest (pleural space). It is done to drain fluid, blood, or air from the lung area.
Thoracostomy is used to treat the following:
- Pneumonia or another lung infection that has caused fluid to build up in the space around the lungs
- An injury to the chest wall that causes bleeding around the lungs
- Infection in the pleural space
- Collapsed lung (pneumothorax)
- Cancer that has caused fluid to build up around your lungs
- The fluid that has accumulated around the lungs during chest surgery
The patient is given general anesthesia before undergoing this surgery. Anesthesia ensures that you are asleep and pain-free during the procedure. You also have an epidural, a small tube in your spine, to administer pain medications during surgery.
While positioned on its side, the surgeon makes an incision 6 to 8 inches below the patient’s shoulder blade, between the ribs. Then, the surgeon divides the muscles and stretches or extracts the ribs to reach the lungs or other parts of the chest.
If the patient undergoes surgery on the lung, the affected lung is deflated with a unique tube so the surgeon can work on it. A breathing tube called a ventilator keeps the other lung functioning.
Thoracotomy is often done with another procedure. To treat lung cancer, surgeons can perform different types of procedures. The surgery you have depends on the stage of cancer.
- Wedge resection removes a wedge-shaped piece from the area of your lung that contains cancer and some healthy tissue around it.
- Segmentectomy removes a segment of a lung.
- Lobectomy removes the lobe of your lung that contains cancer.
- Pneumonectomy removes a whole lung.
- Extrapleural pneumonectomy removes a lung, the lining of your lungs and heart (pleura), and part of your diaphragm.
- It is also possible that the lymph nodes are removed if cancer has spread.
After the procedure is done, the surgeon inflates the lung again. Temporary tubes in the chest drain fluid, blood, and air that may have accumulated around the lungs during surgery. These tubes will remain in place for a few days.
The ribs are then repaired, and the wound is closed with sutures or staples. The whole procedure takes two to five hours.
Side effects and complications
The patient is likely to feel pain and a burning sensation in the chest after the procedure. Your doctor will give you medicines to help control the pain. Usually, the pain will go away in a few days or weeks.
Any surgery can have risks. Possible risks of thoracotomy include:
- Let the air escape from the lungs
- Blood clots in the leg (deep vein thrombosis) can travel to a lung and cause a blockage (pulmonary embolism)
After the surgery, the patient is taken to a recovery room to wake up from the procedure. The nurses monitor your heart rate, blood pressure, breathing, and oxygen levels.
You may have to go through the first day after surgery in an intensive care unit (ICU). Once stable, you will go to a regular hospital ward to recover.
The patient will have to stay in the hospital for four to seven days. During this time, the medical staff will examine you for possible surgery complications.
It can be challenging to breathe at first. The patient should return to normal activities only when he feels ready. It would help if you avoided intense activities like lifting heavy objects six to eight weeks after surgery.
The prognosis depends on the condition that caused the need for surgery. For example, if the patient has cancer, their prognosis will depend on the stage of their disease and the type of surgery performed to treat it.
The incision should heal in a couple of months. The pain should improve gradually during that period. In rare cases, if the nerves are damaged during surgery, the pain may continue for several months after surgery. This is called post-thoracotomy pain syndrome.