Thoracotomy is a major surgical procedure used to access organs in the chest, such as the lungs and heart. Different methods are used, including the common median sternotomy for heart surgery, but minimally invasive alternatives like VATS are becoming more common. Recovery can be painful and involves chest drain tubes and restricted movement. Risks include bleeding, collapsed lungs, and infection.
Thoracotomy is the means by which surgeons gain access to the lungs, heart and other organs located in the chest. It is essentially a cut in the chest wall and there are many different ways a thoracotomy can be performed. It’s a significant procedure in its own right, putting the medical risks at risk. These are usually weighed against whether the incision is needed, 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 the chest for access to the heart, but also cutting through the bone, the breastbone, to provide this access. The sternum is the hard bone located right in the center of the chest. Once the surgery is performed, the sternum needs to be wired so it can regrow and heal properly. This type of thoracotomy is associated with a significant amount of pain during recovery.
For lung access, 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 scapula. Other access areas are possible, and some methods are called minimally invasive because they involve much smaller cuts either to get to the organs under the chest wall intercostally, or between two of the ribs. Smaller cuts can minimize scarring and are generally associated with less pain during recovery.
Regardless of the method used, this is major surgery and not something people can walk away from right away. Most people can expect to spend several days in the hospital recovering from the effects of a thoracotomy, and possibly longer recovering from any surgery that is needed after access to the chest has been gained through the incision. Patients having these procedures are at risk 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 drain tubes for a couple of days and some prescribed restriction in movement in the chest and arms for several weeks. The risks of this surgical procedure in any of its forms include collapsed lungs, fluid in the lungs, infection, and the risk of requiring anesthesia.
In the past, large thoracotomies were performed if doctors needed to visualize the lungs, perform a lung biopsy, or remove lung tumors. There are now some minimally invasive alternatives to this, although they may not be available everywhere. Video-assisted thoracic surgery (VATS) allows for screening of the lungs and removal of some tissue and tumors through a very small cut in the chest wall, which is easier to recover than the incisions required in a thoracotomy. VATS is not recommended in all cases and not all hospitals have the technology to offer this alternative.
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