Thoracotomy

Definition
A thoracotomy is a surgical procedure in which the chest wall (thorax) is opened
, allowing access to the organs beneath it. A lateral thoracotomy provides acces
s to the lungs, major blood vessels, and the esophagus, and an anterior thoracot
omy provides access to the heart and coronary arteries.
Thoracotomy is performed to allow access to a diseased heart, lung, or other org
ans in the chest cavity. It can be used to locate a source of bleeding or obtain
a biopsy sample.
An emergency thoracotomy may be done to assess damage following a severe chest i
njury.

Source: Medical Disability Advisor

Reason for Procedure

Thoracotomy may be needed for lung cancer, other tumors, tuberculosis, lung absc
esses, bronchiectasis, emphysema, collapsed lung, gas in the lung (pneumothorax)
, blood in the lungs (hemothorax), or injuries that have resulted in collapsed l
ung. It is sometimes performed in emergency situations in which traumatic injuri
es and episodes have occurred in the chest and near the heart and lungs, such as
a stab or gunshot wound. It is also often used in conjunction with heart surger
y and in the treatment of recurring pneumothorax or hemothorax.
For biopsy of the lung, of the outer covering of the lung (pleura), of the site
where nerves and vessels enter or leave (hilum), and of the central part of the
thoracic cavity (mediastinum), thoracotomy is the diagnostic gold standard to wh
ich all other procedures must be compared. However, other procedures such as tho
racoscopy and mediastinoscopy have decreased the need for thoracotomy.

Source: Medical Disability Advisor

How Procedure is Performed

Several approaches are available to perform a thoracotomy, and all are done unde
r a general anesthesia.
In anterior thoracotomy, a vertical incision is made from the base of the neck t
o the lower end of the breastbone (sternum). The sternum is divided with a saw (
sternotomy) and gently pried apart. With the heart exposed, the necessary surger
y can be performed.
If access is needed to the esophagus, heart, thymus gland, trachea, bronchi, and
large blood vessels, a full-wide incision thoracotomy is used.
In a lateral thoracotomy, an incision is made between the ribs to allow access t
o the lungs. The incision is made from back to front along the rib line. The rib
s are spread apart, and occasionally part of a rib is removed. The lung may be b
iopsied through the incision.
Following the procedure, a temporary drainage tube is inserted into the pleural
cavity (the space between the membranes lining the chest wall and the membranes
covering the lungs). This allows fluid to drain and permits air in the pleural s
pace to be removed, thereby allowing the lung to fully expand. If the procedure
involved a sternotomy, the sternum is closed with strong stitches or wire. The m
uscles and overlying skin are closed with stitches.

Source: Medical Disability Advisor

Prognosis
The outcome depends on the type and severity of the problem, but many individual
s recover uneventfully. The hospital stay is usually 7 to 10 days. The chest tub
e remains in place until the lung has fully expanded (typically 48 to 72 hours).
Pain is managed with medications.
The procedure may be unsuccessful in treating individuals with massive trauma wh
o are brought to emergency medical facilities.

Source: Medical Disability Advisor

Complications
Complications vary according to the organ or system being examined and treated.
Complications may include reactions to medications, breathing difficulty, bleedi
ng, infections, blood clots, pneumonia, and chronic pain from damage to the nerv
es in the chest. Additionally, lung collapse due to poor post-operative re-expan
sion (atelectasis) or due to a persistent opening between the lung and the chest
wall (bronchopleural fistula) can result. There can also be complications assoc
iated with receiving general anesthesia. Severe cardiac problems may result in d
eath of the individual.

Source: Medical Disability Advisor

Return to Work (Restrictions / Accommodations)

Work restrictions or accommodations depend on the individual's job requirements.
Activities such as lifting, pulling, or pushing heavy objects should be avoided
until the incision has completely healed, which takes approximately 6 weeks. In
dividuals that have jobs that require a lot of standing may need to be restricte
d to more sedentary activity for a couple of weeks. The individual may need to t
ake breaks to perform daily breathing exercises.

Source: Medical Disability Advisor

References
General
Mee, Roger B.B., and Jonathan J. Drummond-Webb. "Lung (Including Pulmonary Embol
ism and Thoracic Outlet Syndrome)." Sabiston Textbook of Surgery. Eds. C. M. Tow
nsend and D. C. Sabiston. 16th ed. Philadelphia: W.B. Saunders, 2001. 1763-1813.