(Lung Surgery; Surgery, Lung)
A thoracotomy is a surgery to open the chest wall. The surgery allows access to the lungs, aorta, heart, diaphragm, and spine. Depending on the disease location, a thoracotomy may be done in the center, or on the right or left side of the chest.
Reasons for Procedure
A thoracotomy may be done to:
- Confirm diagnosis of a lung or chest disease
- Repair the heart or the arteries or veins of the lung and heart
- Treat windpipe disorders
- Remove a portion of the lung or the entire lung
- Reinflate lung tissue that has collapsed due to disease or trauma
- Remove pus from the organs or cavities of the chest
- Remove blood clots from the chest
- Remove tumors or lymph nodes
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Collapsed lung
- Damage to the organs in the chest
- Reaction to anesthesia
- Collection of air or gases in the chest
- Persistent pain—rare
Factors that may increase the risk of complications include:
What to Expect
Prior to Procedure
Your doctor may perform:
- Physical exam
- Blood and urine tests
- X-ray, CT scan, or MRI scan of the chest
- Lung function tests
- Heart function tests
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
Before your procedure, you may need to:
- Use an enema to clear your digestive tract
- Not eat or drink anything after midnight
- Stop smoking at least 2-3 weeks before surgery to reduce the risk of complications
General anesthesia will be given—you will be asleep during the procedure
Description of Procedure
You will be placed on your side with your arm elevated. An incision will be made between 2 ribs, from front to back. The chest wall will then be opened. In some cases, the doctor may take a different approach. The doctor can then do whatever procedure needs to be done in the open chest. When the procedure is done, one or more chest tubes will be placed. The tubes will make sure that blood or air does not collect in the chest. The chest wall will be closed. The incision is closed with stitches or staples and bandaged to prevent infection.
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Immediately After Procedure
You will be closely monitored in the intensive care unit.
How Long Will It Take?
3-4 hours or longer
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
For some, a thoracotomy can lead to a chronic pain syndrome. It is usually described as burning pain in the area of surgery. It may be associated with increased sensitivity to touch in this area. It usually lessens over time, but you may need to see a pain specialist if the pain persists.
Average Hospital Stay
The usual length of stay is 5-10 days. Your doctor may choose to keep you longer if complications arise.
At the Hospital
During your recovery:
- You will have IV lines and tubes in and around your body. Some of the lines and tubes will help you urinate, breath, and get nutrition. Most of the lines and tubes will be removed as you heal.
- You may be given antibiotics, pain medication, or anti-nausea drugs.
- You may need to cough and do deep breathing exercises to keep your lungs clear. This may require the use of a device to help you breathe deeply (an incentive spirometer).
- Get out of bed often and sit in a chair. Slowly increase your activity as tolerated.
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
If you smoke, talk to your doctor about how to successfully quit. You may need to avoid places that expose you to smoke, germs, or chemical irritants. Follow your doctor's instructions.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
- Difficulty breathing or cough
- New pain in the chest or persistent and severe pain in the area of surgery
- Stitches or staples that come apart
- Excessive bleeding at the site of the incision
- Coughing up mucus that is yellow, green, or bloody
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
- Severe nausea or vomiting
If you think you have an emergency, call for medical help right away.
American Thoracic Society
The Society of Thoracic Surgeons
Canadian Society for Vascular Surgery
The Lung Association
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Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J. 2008;14(6):401-409.
Ohbuchi T, Morikawa T, Takeuchi E, Kato H. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg. 1998;46(6):519-522.
Wildgaard K, Ravn J, Kehlet H.Chronic post-thoracotomy pain: A critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170-180.
Last reviewed March 2018 by EBSCO Medical Review Board Alan Drabkin, MD Last Updated: 3/18/2013