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Thoracic Surgery

Thoracotomy

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Thoracotomy is the process of making of an incision into the chest wall. This gives the surgeon access to the thorax, or chest cavity, for the purpose of studying the condition of the lungs, taking a biopsy, removing a tumor, or removing a lung or part of a lung. Lung cancer is the most common condition requiring a thoracotomy.

Thoracotomy also provides access to the heart, esophagus, diaphragm, ribs, and the portion of the aorta that passes through the chest cavity. A resuscitative or emergency thoracotomy may be performed to resuscitate a patient who is near death as a result of a chest injury.

The Surgery

The thoracotomy incision may be made under the arm, through the breastbone, slanting from the back to the side, or under the breast, depending on the reason for the surgery. Muscle layers are cut, and a rib may be removed to gain access to the cavity. Retractors hold the ribs apart, exposing the lung. In some cases, the surgeon is able to make the incision between ribs to minimize cuts through bone, nerves, and muscle. The incision may range from just under 5 inches to 10 inches.

During the surgery, a tube is passed through the trachea. It usually has a branch to each lung. One lung is deflated for examination and surgery, while the other one is inflated with the assistance of a ventilator.

A number of different procedures may be commenced at this point:

  • Biopsy - takes tissue sample to examine for evidence of abnormal cells
  • Wedge resection - removes a wedge-shaped piece of lung smaller than a lobe
  • Lobectomy - removes an entire lobe of a lung
  • Pneumonectomy - removes the entire lung

Once the procedure that required the incision is completed, the cut rib, if that was required, is replaced and held in place with special materials, and the layers of skin, muscle, and other tissues are closed with stitches or staples. If the breastbone was cut, it is stitched back together with wire.

For important information on the general risks of and preparation for thoracic surgery, please see Before Thoracic Surgery.

For post-operative information, please see After Thoracic Surgery.

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