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
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
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.
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.
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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
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