It is done to evaluate and treat pulmonary problems when noninvasive procedures are nondiagnostic or unlikely to be definitive.
Indications
The principal indications for thoracotomy are
Lobectomy
Pneumonectomy
Both lobectomy and pneumonectomy are done most commonly to treat lung cancer.
Video-assisted thoracoscopic surgery Thoracoscopy and Video-Assisted Thoracoscopic Surgery Thoracoscopy is a procedure in which an endoscope is introduced to visualize the pleural space. Thoracoscopy can be used for visualization (pleuroscopy) or for surgical procedures. Surgical... read more has largely replaced thoracotomy for open pleural and lung biopsies.
Contraindications
Contraindications to thoracotomy are those general to surgery and include
Acute cardiac ischemia
Bleeding disorder or anticoagulation that cannot be corrected
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 How To Do Tube and Catheter Thoracostomy Surgical tube thoracostomy is insertion of a surgical tube into the pleural space to drain air or fluid from the chest. Pneumothorax that is recurrent, persistent, traumatic, large, under tension... read more 
for 1 to 2 days and in many cases can leave the hospital in 3 to 4 days.
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. The greatest hazards are
Bronchopleural fistula
Hemorrhage
Infection
Pneumothorax
Reactions to anesthetics
Mortality for exploratory thoracotomy ranges from 0.5 to 1.8%.
