Thoracotomy

What is a thoracotomy?

During a thoracotomy, a surgeon makes a cut between your ribs in order to look at or make contact with or other organs. These other organs include your heart and related blood vessels like your aorta, your esophagus, lungs and trachea. Your provider might also be trying to reach the front of your spine.

Your surgeon will usually make the cut on the left or the right side of your chest, depending on which organ they’re trying to see or treat. In some cases, your surgeon may need to break or remove a rib. The cut goes from your chest and passes under your armpit to your back. The size and exact location of the incision depends on the type of surgery you’re having. It’s also called an open surgery.

Why would I need a thoracotomy?

You may need a thoracotomy so your provider can do a biopsy to remove tissue to make a diagnosis. The procedure may also be used as therapy. You may have a thoracotomy to treat:

• Biopsy to test for a lung condition.
• Removal of lung cancer.
• Cardiovascular conditions.
• Issues with your diaphragm.
• Collapsed lung (pneumothorax).
• Cardiac tamponade (also called pericardial tamponade).
• Esophageal diseases, including esophageal cancer.
• Pleural effusion, or “water around the lungs,” especially if there’s an infection.

What happens before a thoracotomy?

A thoracotomy surgery requires general anesthesia, so you need to be healthy enough to get this type of anesthesia. Your healthcare team will give you instructions on when you need to stop eating or drinking before the surgery.

Make sure you tell your healthcare team about any types of medications, vitamins or supplements you take, even products available over-the-counter. Your providers will let you know what you should do about stopping medications. You may need to stop some medicines, like blood thinners, earlier than others.

For nonemergency thoracotomies, your provider may strongly recommend that you stop smoking.

What happens during a thoracotomy?

During a thoracotomy, your surgical team will put you in position on the correct side with one arm over your head. The team will adjust the arm that’s over your head into a padded holder and will support the other arm and shoulder with a rolled blanket.

Your anesthesiologist will be a specialist in operations involving the thoracic regions and will be able to perform single lung ventilation. Your breathing will happen only in the lung that is on the side that isn’t being operated on.

Your surgeon will cut in between the appropriate set of ribs and may divide or break a rib if necessary. Your surgeon may use electricity to create a heated probe that allows them to get through muscle and other tissue, including bone. They’ll use retractors and a rib spreader to be able to see and/or repair the organs that they’re looking for.

When the incision is closed, you’ll have a tube to help fluids drain and air escape. This is called a chest tube.

What happens after a thoracotomy?

After the thoracotomy, you’ll stay in the hospital for about a week. The chest tube or tubes will remain in for at least a few days.

Your healthcare team will encourage you to cough, use the incentive spirometer and take short walks with assistance. Your team will also help you manage your pain.

If you had a thoracotomy to diagnose a condition, your provider will let you know what they found and what your next steps may be.

What are the risks or complications of a thoracotomy?

Like any surgery, thoracotomies have risks. Some of these include:

• Problems with general anesthesia.
• Infection.
• Bleeding.
• Pain.

Later complications may include:

• Pneumonia, a respiratory infection.
• Atelectasis, a collapse in one or more areas of your lung.
• Post-thoracotomy pain syndrome, which is pain that persists months after the surgery.

What is the recovery time after a thoracotomy?

You’ll be able to go back to your normal eating habits after the procedure. You may want to take a fiber supplement every day to help you avoid constipation. You should be able to drink freely, unless your healthcare provider tells you to limit fluids.

Take your pain medication as directed. Don’t let pain stop you from breathing deeply, which could lead to pneumonia.

You’ll spend about a week in the hospital after a thoracotomy procedure. However, you may be off of work for about two months after this surgery.

You’ll need to follow instructions from your surgical team on when you can resume sexual relations, lifting heavy items and participating in sports.

While you’re home, you’ll need to continue your efforts to improve breathing, which will mean deep breathing, coughing and using the incentive spirometer. Your provider may also suggest exercises for your arms and shoulders.

When should I see my healthcare provider?

Your provider will let you know when you should come for follow-up appointments. You should call your provider with questions if you develop symptoms or signs that worry you. In general, call your provider if:

• You develop a fever.
• You start bleeding again or you cough up blood.
• You have problems breathing.
• Your incision has pus, swelling or if your skin changes colors.
• Your pain is out of control.

What is the difference between a thoracotomy and a sternotomy?

If you have a thoracotomy, the surgeon makes the incision (cut) in between your ribs. If you have a sternotomy, the incision is through your sternum (breastbone). This bone is cracked or divided and then put back together.

What is the difference between a thoracotomy and a thoracostomy?

The incision made for a thoracostomy is to accommodate a tube that can be used to administer medications or to remove fluid. The tube goes into what is called the pleural space or pleural cavity. This area is between your lungs and your chest wall.

The thoracostomy cut is much smaller than the cut between your ribs that happens with a thoracotomy. The two procedures have different purposes.

Is a thoracotomy painful?

Yes, a thoracotomy is painful. The pain may lead to difficulty breathing, which may eventually cause pneumonia or atelectasis. Your healthcare team has multiple ways of controlling the pain. These may include strategies like oral pain meds, intravenous pain medications, or insertion of an epidural catheter to name a few.

There is a possibility that the pain will continue for a long time. This is called post-thoracotomy pain syndrome.

What is a clamshell thoracotomy?

A clamshell thoracotomy combines part of a thoracotomy and a sternotomy. It's used in certain cases where your surgeon needs to see better in the front of your chest as well as the side of your chest. It can be on the right or left side of your chest.

A note from Cleveland Clinic

Your surgeon may recommend a thoracotomy for a number of different reasons. They’ll explain why you’re having a thoracotomy: whether it's to diagnose or treat an illness. It’s major surgery, and it might not be the only one you have. Follow your provider’s instructions before the procedure to do breathing exercises and quit using tobacco. After the surgery, continue to do breathing exercises and keep your pain under control. These are things that will provide the most benefit to you.