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Thoracotomy

by Noah Lechtzin, MD, MHS

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

Contraindications are those general to surgery and include coagulopathy that cannot be corrected, acute cardiac ischemia, and instability or insufficiency of major organ systems.

Procedure

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 and pneumonectomy (eg, lung cancer surgery). Video-assisted thoracoscopic surgery has replaced thoracotomy for open pleural and lung biopsies.

Complications

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. Hemorrhage, infection, pneumothorax, bronchopleural fistula, and reactions to anesthetics are the greatest hazards. Mortality for exploratory thoracotomy ranges from 0.5 to 1.8%.

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