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What is a Thoracotomy?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 16 September 2016
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Thoracotomy is the means by which surgeons gain access to the lungs, heart, and other organs located in the chest. It is essentially cutting into wall of the chest, and there are many different ways a thoracotomy may be performed. It’s a significant procedure on its own, which hazards medical risks. These are usually weighed against necessity for the incision, to do things like remove a lung or perform open-heart surgery.

One of the most common types of thoracotomy for heart surgery is the median sternotomy. This means not only opening up the chest for access to the heart but also cutting through bone, the sternum, to provide this access. The sternum is the hard bone located right at the center of the chest. Once surgery is performed, the sternum must be wired so that it will grow back together and heal appropriately. This type of thoracotomy is associated with a significant amount of pain during recovery.

For access to the lungs, median sternotomy is not always the best choice. Instead surgeons may choose to access the chest by making an incision near the armpit or under the shoulder blade. Other areas of access are possible, and some methods are called minimally invasive because they involve much smaller cuts or to get to the organs under the chest wall intercostally, or between two of the ribs. Smaller cuts may minimize scarring and are generally associated with less pain during recovery.

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No matter what method is used, this is major surgery, and it’s not something that people can immediately walk away from. Most people can expect to spend several days in the hospital recovering from the effects of a thoracotomy, and perhaps longer to recover from whatever surgery was required after access to the chest was derived through incision. Patients who have these procedures run risks of bleeding due to the many blood vessels located in the chest wall, and after the chest wall is closed, they can usually expect to have chest drainage tubes for a couple of days, and some prescribed limitations in movement in the chest and arms for several weeks. Risks of this surgical procedure in any of its forms include collapsed lungs, fluid in the lungs, infection and risk from anesthesia required.

It used to be the case that large thoracotomies would be performed if doctors needed to visualize the lungs, take a lung biopsy or remove lung tumors. There are now some minimally invasive alternatives to this, though they may not be available everywhere. Video assisted thoracic surgery (VATS) allows for screening of the lungs and some tissue and tumor removal through a very small cut in the chest wall, that is easy to recover from as compared to the incisions required in a thoracotomy. VATS is not recommended in all cases and not all hospitals have the needed technology available to offer this as an alternative.

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