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Thoracotomy ˌthōr-ə-ˈkät-ə-mē, ˌthȯr-

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Thoracotomy is an operation in which the chest wall is opened to view the internal chest organs, to obtain samples of tissue for laboratory examination, and to treat disorders of the lungs, heart, or major arteries.

Thoracotomy is a major operation and therefore is used less often than other diagnostic techniques. Thoracotomy is used when procedures such as thoracentesis, bronchoscopy, or mediastinoscopy fail to provide adequate information. The lung problem is identified in more than 90% of people who undergo this operation because the sample site can be seen and selected and because large tissue samples can be taken. Thoracotomy is also often used when cancerous tissue is to be removed from the lung. Thoracotomy allows a surgeon to see and remove all involved tissue.

Thoracotomy requires general anesthesia in an operating room. An incision is made in the chest wall, and tissue samples of the lung are removed for microscopic examination. If specimens are to be taken from areas in both lungs, the breastbone is often split. If necessary, a lung segment, a lung lobe, or an entire lung can be removed.

A chest tube is inserted into the pleural cavity and left in place for 24 to 48 hours afterward. The person usually stays in the hospital for several days. Complications include infection, persistent bleeding, and a persistent leakage of air into the pleural space (pneumothorax).