Merck Manual

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Rebecca Dezube

, MD, MHS, Johns Hopkins University

Last full review/revision May 2021| Content last modified May 2021
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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.


The principal indications for thoracotomy are

  • Lobectomy

  • Pneumonectomy

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


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


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.


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%.

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