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

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Thoracotomy is surgical opening of the chest. It is done to evaluate and treat pulmonary problems when noninvasive procedures are nondiagnostic or unlikely to be definitive.


Contraindications are those general to surgery and include

  • Bleeding disorder or anticoagulation that cannot be corrected

  • Acute cardiac ischemia

  • Instability or insufficiency of major organ systems


Three basic approaches are used:

  • Limited anterior or lateral thoracotomy: A 6- to 8-cm intercostal incision is made to approach the anterior structures.

  • Posterolateral thoracotomy: The posterolateral approach gives access to pleurae, hilum, mediastinum, and the entire lung.

  • Sternal splitting incision (median sternotomy): When access to both lungs is desired, as in lung volume reduction surgery, a sternal splitting incision is used.

Patients undergoing limited thoracotomy require a chest tube for 1 to 2 days and in many cases can leave the hospital in 3 to 4 days.


The principal indications for thoracotomy are

  • Lobectomy

  • Pneumonectomy

Both lobectomy and pneumonectomy are done most commonly to treat lung cancer.

Video-assisted thoracoscopic surgery has largely replaced thoracotomy for open pleural and lung biopsies.


Complications are greater than those for any other pulmonary biopsy procedure because of the risks of general anesthesia, surgical trauma, and a longer hospital stay with more postoperative discomfort. The greatest hazards are

  • Hemorrhage

  • Infection

  • Pneumothorax

  • Bronchopleural fistula

  • Reactions to anesthetics

Mortality for exploratory thoracotomy ranges from 0.5 to 1.8%.