Thoracotomy
It is done to evaluate and treat pulmonary problems when noninvasive procedures are nondiagnostic or unlikely to be definitive.
Indications for Thoracotomy
The principal indications for thoracotomy are
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.
Contraindications to Thoracotomy
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 for Thoracotomy
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 of Thoracotomy
Complications of thoracotomy are greater than those for any other pulmonary procedures 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
