Thoracic Surgery

What is thoracic surgery?

Any operation in your chest (thorax) is thoracic surgery. While your heart is the best-known organ in your chest, thoracic surgery includes lung surgery and much more. It also includes surgery of your:

• Esophagus (food pipe).
• Trachea (windpipe).
• Diaphragm.
• Chest wall (ribs, breastbone and the muscles around them).
• Mediastinum (the area between your lungs).

A surgeon can perform thoracic surgery using an open or minimally invasive approach. With open surgery, there’s a larger incision. With minimally invasive surgery, surgeons use smaller incisions and place a video camera through your chest.

With the video camera in your chest, surgeons use small, long instruments to perform the procedure through other small incisions. They can do minimally invasive surgery with handheld video cameras and instruments. The name for this is VATS surgery in the chest or laparoscopic surgery in the abdomen.

Surgeons can also do minimally invasive surgery with the assistance of a robot that holds the instruments and camera, but the surgeon still controls these.

What does thoracic surgery treat or manage?

Thoracic surgery includes any operation to treat an issue in your chest and upper abdomen, such as:

• Stretched blood vessels (aneurysms).
• Congenital (present at birth) heart issues.
• Irregular heart rhythms.
• Heart failure.
• Coronary artery disease.
• Heart or lung transplants.
• Heart valve issues.
• Lung cancer.
• Tumors in your esophagus or thymus.
• Swallowing issues (dysphagia).
• Gastroesophageal reflux disease (GERD).
• Barrett’s esophagus.
• Hiatal hernias.

What is the most common thoracic surgery?

Coronary artery bypass grafting (CABG) and lobectomy (removing part of your lung) are the most common thoracic surgeries. CABG is the world’s most common heart surgery. In the U.S., surgeons perform about 200,000 CABG surgeries each year.

Surgeons performed more than 13,000 lobectomies in 2019 in the U.S.

Is thoracic surgery serious?

Yes, many thoracic surgeries are serious. Your heart and lungs are very important organs, and they need to function well. Some people need complicated surgeries to fix more than one heart issue. Others may need a minimally invasive lung surgery. In either case, a healthcare team will be focused on working together to give you the best surgical outcome.

What happens before thoracic surgery?

Depending on the type of operation you’re having, you may need blood tests before thoracic surgery.

For heart issues, other tests may include imaging or tests that measure your heart rhythm and function.

For lung issues, you’ll need imaging and tests that measure how well your lungs work (pulmonary function). A provider also may use one of several methods to take tissue samples from your lungs. They may ask you to walk up several flights of stairs or in a line for six minutes to predict your risk of complications.

After reviewing your test results, a thoracic surgeon can plan your surgery.

How can I prepare for thoracic surgery?

The following steps can help you prepare for thoracic surgery:

• Be sure to tell your provider about any medicines you take, even those you buy without a prescription.
• If your provider tells you to, stop taking certain medicines a few days before your surgery. Don’t stop taking any medicines unless your provider tells you to.
• Stop using tobacco products at least a month before lung surgery. This and avoiding tobacco for a month after surgery can cut your risk of wound complications in half.
• Stop eating and drinking at the time your provider tells you to on the day of or night before surgery.
• Make a plan for your recovery.
• Ask a family member or friend to drive you home and stay with you for a few days.
• Because it’ll take time to recover from thoracic surgery, you may want to prepare meals ahead of time and freeze them to make things easier.

What happens during thoracic surgery?

After you receive anesthesia in an IV to put you to sleep, you’ll get a breathing tube. Also, depending on the type of thoracic surgery, a machine may handle your heart’s and lungs’ functions for you during your surgery.

Your provider will:

1. Make the needed incisions in a traditional or minimally invasive way. Your surgeon may cut through your breastbone (sternotomy) or between your ribs (thoracotomy) to reach the area.
2. Repair, remove and/or replace the organ or body part that requires surgery.
3. Check for bleeding.
4. Close all incisions.

What to expect after thoracic surgery

After thoracic surgery:

• You’ll wake up in a recovery room or intensive care unit.
• A provider will remove your breathing tube.
• You’ll likely have tubes in your chest to provide drainage and a catheter in your bladder to collect pee.
• When your provider decides that you’re ready, they’ll move you to a regular hospital room.
• As soon as you’re able to, you’ll walk around your room and hallway with assistance.
• You may also do breathing exercises to help re-expand your lungs.
• Once you’ve reached the goals your provider set for you, you can go home. This usually happens after three to 10 days, depending on the type of surgery.

What are the advantages of thoracic surgery?

Thoracic surgery can save or extend your life if you’re having a serious issue with your heart or lungs. Also, thoracic surgery can have a major impact on your quality of life by helping your heart or lungs work better. Thoracic surgery can help with difficulty swallowing or other issues that affect you on a daily basis.

What are the risks or complications of thoracic surgery?

Risks of thoracic surgery include:

• Infections, including pneumonia.
• Lung collapse.
• Blood clots.
• Depression.
• Abnormal heart rhythms.
• Heart failure.
• Swelling in your lung (pulmonary edema).

How long does it take to recover from thoracic surgery?

Thoracic surgery recovery time varies depending on the type of operation you had. You may spend a week in the hospital after your thoracic surgery. But if you had minimally invasive surgery, you may need only three or four days to recover.

You may need a month or more to recover completely.

When can I go back to work or drive?

Depending on the type of thoracic surgery you had, you may not be able to drive for a month. Also, you may have limits on how much you can lift for six weeks after surgery.

When should I see my healthcare provider?

Contact your provider if you’re having:

• Chest pain.
• Shortness of breath.
• Bleeding.
• Issues with your incisions.
• Fever.

A note from Cleveland Clinic

Thoracic surgery includes a wide variety of operations a provider performs in your chest. Procedures can range from straightforward to complex. Surgeons can use open or minimally invasive approaches, selecting the best option for your situation. Be sure to ask them if there’s anything you don’t understand about your procedure. Having more information about it can make you feel more comfortable about having surgery.