A thoracotomy is surgery to open your chest. During this procedure, a surgeon makes an incision in the chest wall between your ribs, usually to operate on your lungs. Through this incision, the surgeon can remove part or all of a lung.
Thoracotomy is often done to treat lung cancer. Sometimes it’s used to treat problems with your heart or other structures in your chest, such as your diaphragm. Thoracotomy can also be used to help diagnose disease. For example, it can enable a surgeon to remove a piece of tissue for further examination (biopsy).
Thoracotomy vs. thoracostomy
Though thoracotomy and thoracostomy look almost the same, the terms describe two very different procedures:
- Thoracotomy is surgery that makes an incision to access the chest. It’s often done to remove part or all of a lung in people with lung cancer.
- Thoracostomy is a procedure that places a tube in the space between your lungs and chest wall (pleural space). It’s done to drain fluid, blood, or air from the area around your lungs.
Thoracostomy is used to treat the following:
- pneumonia or another lung infection that has caused fluid to build up in the space around your lungs
- an injury to the chest wall that causes bleeding around your lungs
- infection in the pleural space
- collapsed lung (pneumothorax)
- cancer that has caused fluid buildup around your lungs
- fluid that has collected around your lungs during chest surgery
You’re given a general anesthesia before having this surgery. The anesthesia ensures that you’re asleep and pain-free during the procedure. You’ll also have an epidural, which is a small tube in your spine, to deliver pain medicine during the surgery.
While you’re positioned on your side, the surgeon makes a 6- to 8-inch incision below your shoulder blade, between your ribs. The surgeon then divides your muscles and spreads or removes ribs to reach your lungs or another part of your chest.
If you’re having surgery on your lung, the affected lung is deflated with a special tube so the surgeon can work on it. A breathing tube called a ventilator keeps the other lung working.
Thoracotomy is often done with another procedure. To treat lung cancer, surgeons can perform a few different types of procedures. Which surgery you have depends on the stage of your cancer.
- Wedge resection removes a wedge-shaped piece from the area of your lung that contains cancer and some healthy tissue around it.
- Segmentectomy removes one segment of a lung.
- Lobectomy removes the lobe of your lung that contains cancer.
- Pneumonectomy removes an entire lung.
- Extrapleural pneumonectomy removes a lung, the lining of your lungs and heart (pleura), and part of your diaphragm.
You might have lymph nodes removed as well, if the cancer has spread.
After the procedure is done, the surgeon reinflates your lung. Temporary tubes in your chest drain fluid, blood, and air that may have collected around your lungs during the surgery. These tubes will stay in place for a few days.
Your ribs are then repaired and the wound closed with sutures or staples. The entire procedure takes two to five hours.
Side effects and complications
You’ll likely have some pain and a burning sensation in your chest after the procedure. Your doctor will give you medicine to help manage the pain. Usually the pain will go away in a few days or weeks.
Any surgery can have risks. Possible risks from thoracotomy include:
- air leaking from your lungs
- blood clot in your leg (deep vein thrombosis) that can travel to a lung and cause a blockage (pulmonary embolism)
After surgery, you’re taken to a recovery room to wake up from the procedure. Nurses monitor your heart rate, blood pressure, breathing, and oxygen levels. You may need to spend the first day after surgery in an intensive care unit (ICU). Once you’re stable, you’ll go to a regular hospital room to recover.
You’ll need to stay in the hospital for four to seven days. During that time, the medical staff will check you for possible complications of your surgery.
It may be hard for you to breathe at first. Ease back into your normal activities only when you feel ready. You’ll need to avoid intense activities like heavy lifting for six to eight weeks after your surgery.
Your outlook depends on the condition that caused you to need surgery. For example, if you have cancer, your outlook will depend on the stage of your disease and the type of surgery performed to treat it.
The incision should heal within a couple of months. Pain should gradually improve over that time period. In rare cases, if nerves were damaged during the surgery, the pain may continue for as long as several months after your surgery. This is called post-thoracotomy pain syndrome.
Contact your doctor if you suspect you’re experiencing any side effects or complications as a result of the surgery.