Thoracotomy: Procedures and recovery
This article looks at the various uses of a thoracotomy, how the procedure works, and what the outlook is after surgery.
What is a thoracotomy?
A thoracotomy may be required for a number of reasons, including treating lung cancer.
A thoracotomy is an incision made in the chest. Surgeons and doctors in emergency situations may use it to access the organs within the chest.
The organs in the chest or thorax are called the thoracic organs. These include:
- food pipe or esophagus
A thoracotomy also allows access to part of the aorta, which is the body's largest artery.
Thoracotomies are often used to treat or diagnose a problem with one of these organs or structures.
The most common reason to have a thoracotomy is to treat lung cancer, as the cancerous part of the lung can be removed through the incision. It can also be used to treat some heart and chest conditions.
There are various uses for a thoracotomy. These include:
Lung cancer treatment
Opening the chest allows the doctor to operate on the lungs, as part of lung cancer treatment.
Removal of a rib
Removal of a rib, or part of a rib or resection, may be necessary if the bone has fractured in a way that means it might puncture an organ.
It may also be necessary to remove all or part of a rib if the bone has become cancerous.
A thoracotomy to open the chest gives the doctor access to a person's ribs, making these surgeries possible.
In an emergency situation, such as when someone has a chest injury, a thoracotomy may be needed to resuscitate them.
An emergency thoracotomy opens up the chest, allowing the doctor to:
- control bleeding from the heart or thoracic blood vessels
- carry out cardiac compressions to pump blood
- relieve pressure on the heart from any accumulated fluid
These procedures give the doctor the chance to save a person's life.
Different incisions will be used depending on the reason for the surgery.
Before undergoing a thoracotomy, a person will be put under general anesthetic. They may also be given an epidural, which delivers pain medication into the spine. These measures ensure the person is asleep and unable to feel anything during the surgery.
To carry out a thoracotomy, the doctor will make an incision in the chest. There are different places on the chest that the incision can be made, depending on the reason for the thoracotomy.
- Axillary thoracotomy: This is where an incision is made into the thorax from the side, under a person's arm.
- Median sternotomy: This is where an incision is made into the thorax from the front, through the person's breastbone.
- Intercostal approach: This is where the incision is made between the ribs to reduce that amount of damage to muscles, nerves, and bones.
- "L shaped" thoracotomy: This is an unusual type of thoracotomy performed in an emergency situation before a person reaches the hospital. According to a 2010 study, the procedure can be carried out with minimal equipment.
During the operation, a tube is passed down the windpipe to enable the lung being operated on to be deflated. When this is happening, a mechanical device keeps the other lung inflated.
After this, lung cancer treatment, rib removal, or resuscitation can be carried out.
If a person is being treated for lung cancer, there are different procedures available, depending on the severity and location of the cancer.
Lung cancer procedures
When a person is being treated for lung cancer, the doctor may carry out one of the following procedures:
- Lobectomy: This is where the lobe of lung tissue affected by cancer is removed.
- Segmentectomy: Also known as a wedge resection, this is where a small wedge-shaped piece of lung is removed.
- Resection: This is where a tumor or growth on the lung is removed through an incision.
- Pneumonectomy: If cancer has spread throughout the organ, a thoracotomy allows the doctor to remove the whole lung.
- Biopsy: This is when a sample of tissue is taken to help diagnose a disease. Opening the chest allows the doctor to access any of the thoracic organs to take the sample.
There are several risks and potential side effects associated with a thoracotomy, including:
Side effects of anesthetic
It is important to discuss side effects and risks with a medical professional before undergoing a thoracotomy.
A thoracotomy requires a person to be put under general anesthetic so that they are not awake during the procedure and do not feel any pain.
Using general anesthetic may have the following side effects:
Risk of hemorrhage
During the operation, there is a risk of hemorrhage or excess bleeding. This is because the lungs have many blood vessels that may be damaged during the procedure.
Risk of blood clot
There is also a risk of developing a blood clot during a thoracotomy. This may start in the leg, which is called deep vein thrombosis.
Although rare, this clot may travel to the lung, causing a pulmonary embolism, which is a sudden blockage of a major artery in the lung.
Risk of a collapsed lung
When the tube is removed from the chest after the operation, there is a risk of something called pneumothorax or a collapsed lung. This is where air gets trapped between the lung and the chest wall, causing sharp pain.
To reduce the risk of this, the doctor will remove the tube just after the person has inhaled or exhaled.
Risk of infection
After the surgery, some liquid may drain from the incision. It is vital to keep the wound clean and dry to reduce the risk of infection.
Risk of pneumonia
There is also a risk of pneumonia after surgery. Deep breathing and coughing exercises help to reduce the risk of developing this lung condition.
Pain relief is essential after surgery, as it makes deep breathing and coughing easier. Breathing and coughing without pain can help speed up recovery.
Risk of paralysis
In rare cases, people have experienced paraplegia after a thoracotomy. This 2002 study explores three cases where this has occurred.
Thoracotomy vs. thoracostomy
A thoracotomy and a thoracostomy sound similar, but they are two different procedures.
A thoracotomy is an incision in the chest and is normally carried out so the doctor can operate on the heart, lungs, or other structures in the chest. This is a way to treat lung cancer.
In contrast, a thoracostomy is a procedure that is used to drain the space between the lungs and chest wall of excess fluid, blood, or air.
A thoracostomy may be necessary if a person has:
- a lung infection, such as pneumonia
- a chest injury that is causing bleeding
- an infection in the pleural space between the lungs and chest wall
- fluid buildup caused by cancer or chest surgery
A thoracostomy is done using a tube that is placed in the space between the lungs and the chest wall.
Outlook and recovery
The outlook for a person who has had a thoracotomy depends on the reason they had the procedure. For example, if the thoracotomy is for lung cancer, a person's outlook depends on the stage of the disease.
The thoracotomy wound should heal within 2 months, and the pain will gradually decrease over this time.
In some cases, nerves become damaged during surgery. This may cause ongoing pain and is called post-thoracotomy pain syndrome.
If a person experiences pain or side effects after surgery, they should speak to their doctor as soon as possible.