You probably know that if an organ inside your chest, such as your heart or lungs, becomes ill, you sometimes need to have surgery to treat it. So, at such a time, a surgeon needs to go inside your chest and look at that organ, examine it, or remove part of it. One of the main types of surgery that is done for this kind of thing is what we are talking about today, a thoracotomy.
Simply put, what is a thoracotomy?
A thoracotomy is a surgical procedure in which a surgeon makes an incision between two of your ribs to open up your chest cavity. This opens the chest and allows the doctor to directly view, touch, examine, and treat the organs inside.
Imagine you need to treat an organ like your heart, the aorta, the esophagus, the lungs, or the trachea. Sometimes this surgery is also used to reach the front of the spine.
This incision is usually made on the left or right side of the chest. This depends on the side of the organ that needs to be treated. In some cases, a rib may need to be broken or even removed. This incision is made from the chest to the back under the armpit. The size and location of the incision depend on the type of surgery you are having. This is also called "open surgery."
Why would someone want to have this kind of surgery?
There are several reasons why a thoracotomy may be performed. Sometimes, it is done to remove a piece of tissue for examination, called a biopsy, to determine the exact cause of a disease. It is also done as a treatment for a disease.
Let's look at the table below to see what the main reasons are for this surgery.
| Reason for surgery | A simple explanation |
|---|---|
| Biopsy to diagnose lung disease | To find out exactly what the problem is with the lungs, take a piece of tissue and examine it. |
| Lung cancer removal | Remove a cancerous tumor or part of a lung. |
| Cardiovascular conditions | Treat certain problems in the heart or related large blood vessels. |
| Diaphragm problems | Treat certain problems in the diaphragm that separates the chest and abdomen. |
| Pneumothorax | Treat air leaks into the lungs and becomes contaminated. |
| Cardiac Tamponade | If fluid accumulates inside the sac around the heart and puts pressure on the heart, remove it. |
| Esophageal diseases | Treat throat cancer or other conditions. |
| Pleural Effusion | When there is fluid accumulation around the lungs, especially with an infection, remove the fluid. |
What happens before the surgery?
This is a major surgery and you will need to be under general anesthesia. Therefore, you should be in good health to tolerate this type of anesthesia. The medical team will advise you on when to stop eating and drinking before the surgery.
It is important to tell your healthcare team about any medications, vitamins, or supplements you are taking, even those you can buy over-the-counter. You may be advised to stop taking some medications sooner than others, especially blood thinners .
For non-emergency surgery, if you are a smoker, doctors will strongly advise you to quit .
What happens during the surgery?
During the operation, the surgical team will turn you to the correct side, place one arm above your head in a special holder, and support your other arm and shoulder with a rolled blanket.
Your anesthesiologist is a specialist in thoracic surgery. He or she may perform a procedure called "single lung ventilation." Simply put, this involves temporarily shutting down the lung on the side being operated on, allowing you to breathe only through the other lung. This gives the surgeon more room to operate.
The surgeon then makes an incision between the two ribs. If necessary, a rib may be broken or split. A special device that uses heat to penetrate the muscles and other tissues may also be used. Special instruments (retractors and rib spreaders) are then inserted to create space inside the chest to view and treat the organs.
After the surgery is complete and the incision is closed, a chest tube is placed to allow the fluid and air that collects inside to drain out.
What happens after the surgery?
After the surgery, you will need to stay in the hospital for about a week. The chest tube will remain in place for a few days.
During this time, your medical team will encourage you to cough, use a special breathing device (incentive spirometer), and walk around a bit with assistance . Doing these things is very important for your lungs to recover. They will also help control your pain.
If your surgery was performed to diagnose a disease, the doctor will explain it to you and advise you on what to do next.
What are the risks and complications of this surgery?
Like any surgery, there are risks involved in a rhinoplasty. Let's take a look at them in the table below.
| Risks associated with surgery | |
|---|---|
| Immediate risks of surgery | |
| Problems related to anesthesia | Adverse reactions of the body to general anesthesia. |
| Infection | Infection of the surgical wound or inside the chest. |
| Bleeding | Excessive bleeding during or after surgery. |
| Pain | Severe pain around the surgical incision and ribs. |
| Possible complications later | |
| Pneumonia | A respiratory infection in the lungs (exacerbation of a cold). |
| Atelectasis | Collapse of one or more parts of the lungs. |
| Post-thoracotomy pain syndrome | Prolonged pain that persists for months after surgery. |
How long does it take to heal?
You can eat normally after surgery. However, it is best to eat a diet high in fiber to prevent constipation. Unless your doctor tells you to limit fluids, drink plenty of water.
Take painkillers exactly as prescribed. Don't stop breathing deeply because of the pain. Doing so can lead to pneumonia.
The most important thing is to control the pain, breathe well, and cough. This can go a long way in preventing lung complications.
You will need to stay in the hospital for about a week. However, it may take up to two months to return to work after this surgery. Ask your surgical team when you can resume activities such as having sex, lifting weights, and playing sports.
Even after you go home, you should continue to practice deep breathing, coughing, and using an incentive spirometer. Your doctor may also recommend exercises for your arms and shoulders.
When should I see the doctor again?
Your doctor will tell you when you need to be seen again. But before that, if you have any questions or concerns, talk to your doctor. You should definitely see a doctor, especially if you have any of the following symptoms:
- If you get a fever.
- If the wound starts bleeding again or if you cough up blood.
- If you have difficulty breathing.
- If you see pus, swelling, or a change in skin color at the incision site.
- If the pain becomes too much to control.
What is the difference between Thoracotomy, Sternotomy and Thoracostomy?
These three names are a bit similar, so it can be confusing. Let's see what the difference is.
| Type of surgery | Incision location and purpose |
|---|---|
| Thoracotomy | The incision is made between two ribs . The goal is to open the chest and treat the organs. |
| Sternotomy | The incision is made through the breastbone (sternum) in the middle of the chest. This bone is cut in two and the surgery is performed. This method is often used for heart surgery. |
| Thoracostomy | A very small incision is made in this. The purpose is to insert a tube (chest tube). Through this tube, medication can be given or fluid/air that collects around the lungs can be removed. This incision is much smaller than a thoracotomy incision. |
Is this surgery very painful?
Yes, a thoracotomy is a painful surgery. It's true. This pain can cause difficulty breathing, which can lead to conditions like pneumonia or atelectasis.
But don't worry. Your medical team has several ways to manage this pain. Oral painkillers, intravenous painkillers, or an epidural catheter placed in your spine can help you manage your pain.
Sometimes this pain can last for a long time. This is called post-thoracotomy pain syndrome, which we talked about earlier.
Finally, if your doctor recommends a thoracotomy, make sure you have a good discussion with him about the reason for the surgery and what to expect. This is a major surgery. Therefore, it is very important for your speedy recovery that you follow the doctor's instructions, especially about quitting smoking before the surgery, doing breathing exercises, and managing pain after the surgery.
Take-Home Message
- A thoracotomy is a large, open surgery performed through an incision in the chest between the ribs.
- This is done to treat organs like the lungs and heart or to diagnose a disease.
- Follow your doctor's instructions carefully before surgery, especially regarding quitting smoking.
- After surgery, controlling pain, coughing well, and breathing deeply are essential to prevent lung complications.
- The recovery period can be long. It may take several months to fully recover, so be patient.
- If you develop warning signs such as fever, severe pain, or difficulty breathing, notify your doctor immediately.
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