What is a thoracotomy?
In a thoracotomy, the surgeon opens the chest through an incision between the ribs. There are different variations depending on the location and size of the incision.
Posterolateral thoracotomy
Posterolateral (“from behind and to the side”) thoracotomy is the most common type of thoracotomy. Because the incision runs in an arc from the scapula to the chest between the fifth and sixth ribs (5th intercostal space, 5th ICR), it results in a large access into the chest on the one hand, and on the other hand, many structures such as muscles and tissues are injured.
Anterolateral thoracotomy
Anterolateral (“from the front and side”) thoracotomy is the most important and also a tolerable alternative to posterolateral thoracotomy. The incision is made in an arc below the base of the chest from the middle of the axilla to the sternum. Thus, the broad muscle of the back (latissimus dorsi muscle) is spared. In addition, the ribs are spread less apart during this procedure.
Clamshell thoracotomy
Axillary thoracotomy
Axillary (“in the armpit”) thoracotomy is a very muscle-sparing procedure and leaves little scarring It is not, however, suitable for major surgery. The incision is in the fourth intercostal space (intercostal space).
Small diagnostic thoracotomy (minithoracotomy)
A minithoracotomy involves making an incision only about six to eight centimeters long. It is used, for example, to remove tissue samples from the lungs or to place tubes to drain blood or other body fluids (chest drains).
Median sternotomy
In a median (“middle”) sternotomy, the surgeon cuts through the sternum along its long axis.
When do you perform a thoracotomy?
A thoracotomy is done whenever the surgeon needs to operate inside the chest. This includes procedures on the lungs, heart, aorta and esophagus. Thoracotomy also helps to get a quick overview of the situation inside the chest in emergency situations, such as bleeding, and act accordingly.
What do you do during a thoracotomy?
In most thoracotomies, the patient lies on his or her side (lateral positioning). As soon as the general anesthesia takes effect, the surgeon makes the skin incision, depending on the variant, and works his way through the underlying fatty tissue to the muscles. These are cut through as gently as possible, the intercostal space is opened and slowly widened with the help of a so-called rib retractor. This gives the surgeon access to the thoracic cavity, where he can perform further surgical procedures.
Before closing the thoracotomy, thoracic drains may be placed to allow blood or other body fluids to drain. The surgeon removes the rib retractor and sutures the intercostal space. Last, muscle and tissue layers and skin are closed with sutures.
In median sternotomy, the sternum must be cut using a bone saw to open the chest. During the sternotomy, the patient lies on his back. Wires are used to stabilize the sternum so that it can grow together properly after surgery.
What are the risks of a thoracotomy?
- Post-operative bleeding
- Cardiac arrhythmias
- Heart failure
- Pneumonia
- Rib fractures
- Injury to nerves
- Wound healing disorders
What do I need to be aware of after a thoracotomy?
Aftercare measures for thoracotomy also depend on the reason for the procedure. The surgeon will discuss the course of the surgery and follow-up with you in a final consultation. Drainage tubes remain in the wound for approximately one to five days. Stitches are usually removed after two weeks, when the suture has healed.
Because thoracotomy is a major procedure, you should take it easy in the weeks afterward. Your attending physician will let you know when and how you can resume weight-bearing. Physical therapy afterward may help restore muscle and joint mobility.
