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Thoracotomy
Introduction

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:
 Heart
 Lungs
 Food pipe or esophagus
 Diaphragm

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.

Uses
A thoracotomy may be done for several reasons, not just the removal of cancer. Opening and
exposing the chest cavity and mediastinum (the area between the lungs) can give surgeons access
to the heart, lungs, esophagus, the upper part (thoracic) or the aorta, and the front (anterior part)
of the spine.

Some indications include:

 Lung cancer surgery
 Esophageal cancer surgery
 Heart/aortic surgery
 Chest trauma
 Persistent pneumothorax (collapsed lung)
 Management of COPD
 Tuberculosis
 Biopsy and evaluation of an unknown mediastinal mass
 Surgery to the anterior spine
 Resuscitative thoracotomy (emergency thoracotomy): This is a procedure done in the
emergency room for life-threatening emergencies such as chest hemorrhage
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Types of Procedures

There are several different types of thoracotomy that can be performed, depending on the
indication for surgery and condition being treated. These include:

 Posterolateral thoracotomy / (Intercostal approach): This is the most common

procedure and the usual method of gaining access to the lungs to remove a lung or a
portion of a lung to treat lung cancer. An incision is made along the side of the chest
towards the back between the ribs. The ribs are then spread apart (a rib may also be
removed) to visualize the lungs. Surgeons may then remove a lung (pneumonectomy), a
lobe of one of the lungs (lobectomy), or a smaller portion of the lung (wedge resection).

 Median thoracotomy / (Median sternotomy): In a median thoracotomy, surgeons make

an incision through the sternum (the breastbone) to gain access to the chest. This
procedure is commonly done to perform surgery on the heart.
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 Axillary thoracotomy: In an axillary thoracotomy, surgeons gain access to the chest

through an incision near the armpit. This is commonly done for treating
a pneumothorax (collapsed lung), but may also be performed for some heart and lung
surgeries.

 Anterolateral thoracotomy / (“L shaped” thoracotomy): This procedure is an

emergency procedure involving an incision along the front of the chest. It may be done
following major chest trauma, or to allow direct access to the heart after a cardiac arrest.

Possible Complications

Some people go through a thoracotomy without experiencing any complications, whereas others
may encounter one or more setbacks. It's important to talk carefully with surgeon about the
specific surgery and what to expect. Certainly, those who are healthier in general prior to the
procedure will likely have an easier course than those who are coping with additional medical
concerns. And as with any surgery, smoking can increase the risk of serious complications.

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:

 Nausea
 Vomiting
 Headache
 Blood pressure problems
 Allergic reaction
 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.
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 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.
(Mainly vocal cord dysfunction or paralysis)
 Prolonged need for ventilatory assistance after surgery
 Persistent air leak resulting in a prolonged need for a chest tube after surgery
 Heart attack or arrhythmias
 Bronchopleural fistula - This is a complication in which an abnormal passageway forms
between a bronchial tube and the space between the membranes (pleura) lining the lungs.
 Post pneumonectomy syndrome or post-thoracotomy pain syndrome - Pain in the region
of a thoracotomy may sometimes persist for a long time after surgery.

Post-operative PT management
 Physiotherapy includes deep breathing exercise
 Coughing exercise
 Incentive spirometry
 Limb Exercise.