Thoracotomy

A thoracotomy is a procedure where a surgeon makes a cut between your ribs so they can look at or access organs in your chest. These organs include your heart, your main blood vessel (aorta), your esophagus, diaphragm, lungs and trachea. Your provider might also use this procedure to reach the front of your spine.

Surgeons call this procedure an open thoracotomy because it’s not minimally invasive. 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, they may need to remove a small section of the rib.

The size and exact location of the thoracotomy incision depend on the type of surgery you’re having. Surgeons may talk about the types of thoracotomy as anterolateral (in front and on the side) or posterolateral (in back and on the side). This describes where they’re cutting.

When is it necessary?

You may need a thoracotomy so your provider can treat you or remove tissue (biopsy) to make a diagnosis. You may have this procedure to treat:

• Lung cancer
• Heart and blood vessel conditions or trauma
• Issues with your diaphragm
• Collapsed lung (pneumothorax)
• Excess fluid around your heart (cardiac tamponade)
• Esophageal diseases, including cancer
• Excess fluid around your lungs (pleural effusion)

How should I prepare for a thoracotomy?

A thoracotomy surgery requires general anesthesia to keep you from feeling pain. To be healthy enough for this, you may need to stop smoking before surgery.

Make sure you tell your healthcare team about any medications and vitamins you take. This includes supplements and other products you buy over the counter. Some of these may increase your risk of bleeding.

Your provider will tell you when to stop taking medicines. It’ll likely be about a week before surgery. Don’t stop taking them until your provider tells you to stop.

Your healthcare team will tell you when you need to stop eating or drinking before the surgery.

What happens during this procedure?

During a two- to four-hour thoracotomy, your surgical team will:

1. Put you in position on the correct side with one arm over your head
2. Ventilate one lung on the side that isn’t being operated on
3. Make a cut (incision) between two ribs
4. Remove a small portion of a rib if necessary
5. Use tools to see and work on the organs that need care
6. Put in a chest tube to help extra fluids drain and air escape
7. Close the cut

What are the potential risks of this procedure?

A healthcare provider may need to do a thoracotomy to complete a procedure if scar tissue or other circumstances prevent a minimally invasive approach.

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

• Problems with general anesthesia
• Infection
• Bleeding
• Pain
• Pleural effusion

Your healthcare team can help you manage pain with medicines you receive by mouth, through an IV or through a catheter in your back. The pain should go away in days or weeks.

Late complications may include pneumonia or a collapse in one or more areas of your lung (atelectasis). Some people have pain that lasts more than two months after the surgery (post-thoracotomy pain syndrome).

What happens after a thoracotomy?

After a thoracotomy, the chest tube or tubes will stay in for at least two days. A provider will remove them when your lung expands fully, and you don’t need drains for air or fluid anymore.

Your healthcare team will ask you to cough, use a breathing aid (spirometer) and take short walks. Your team will also help you manage your pain.

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

What is the recovery time?

You’ll spend about a week in the hospital after a thoracotomy. But you may be off work for about two months. You can expect to feel tired during this time.

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 fluids freely, unless your healthcare provider tells you to limit them.

Walking a little every day helps with blood flow and may prevent pneumonia. You’ll need to follow instructions from your surgical team on when you can have sex, lift heavy items and take part in sports.

While you’re home, you’ll need to keep improving your breathing. Your provider may also suggest exercises for your arms and shoulders.

Take your pain medication as directed.

When should I call my healthcare provider?

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

• You develop a fever
• You start bleeding, or you cough up blood
• You have an upset stomach
• You have problems breathing
• Your incision has pus, swelling or your skin changes colors
• Your pain doesn’t improve with medicine

What is the difference between a thoracotomy and a sternotomy?

If you have a thoracotomy, the surgeon makes the incision (cut) between your ribs. If you have a sternotomy, the incision is through your sternum (breastbone). The surgeon divides this bone and then puts it back together.

What is the difference between a thoracotomy and a thoracostomy?

The incision for a thoracostomy is for a tube providers use to give medications or 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.

What is a clamshell thoracotomy?

A clamshell thoracotomy combines part of a thoracotomy and a sternotomy. Surgeons use it in certain cases when they need 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.