Thoracotomy

Thoracotomy is a surgical procedure in which a cut is made between the rib bones to access the organs inside the chest. These organs include the heart, windpipe (trachea), lungs, and food pipe (oesophagus).

This surgery is performed in two ways:

• Open surgery: In this surgery, an incision (cut) is made to the right or left side of the chest. 
• Thoracoscopic surgery: In this method, the surgeon makes multiple small cuts inside the chest wall and uses a special instrument with a camera to see inside.

Rarely, the surgeon cuts the front part of the chest through the breast bone (the flat bone between the left and right ribs).

A surgeon may recommend this surgery if you have the following conditions or their symptoms:

Lung cancer: The surgeon may remove a portion of the lung or an entire lung for the treatment of early stage of lung cancer. Symptoms of lung cancer may include:

• Cough for up to two to three weeks 
• Persistent breathlessness 
• Blood in cough
• Unexplained weight loss
• Loss of appetite 
• Pain while breathing or coughing
• Recurring chest infections
• Poor energy or persistent tiredness

Benign (non-cancerous) lung condition: Symptoms of benign tumour in the lungs are as follows:

• Wheezing 
• Persistent cough
• Blood in cough 
• Difficulty in breathing
• Increased chances of pneumonia

Broken ribs: The symptoms of broken ribs include: 

• Bruising of the skin 
• Cracking sound in the ribs 
• Swelling or tenderness around the ribs 
• Sharp pain in the chest

Thoracotomy is also used to treat other lung conditions like: 

• Pulmonary embolism
• Atelectasis (complete or parital collapse of a lung or a part of a lung)
• Obstructive pulmonary disease
• Emphysema or bronchiectasis (enalrgement of some parts of lungs that leads to cough)
• Pneumothorax

Thoracotomy can be done for heart surgeries and emergency conditions like cardiac bleeding or bleeding in the thoracic cavity.

There are no absolute contraindications to thoracotomy when performed as an emergency procedure, but relative contraindications (when surgery can be performed, but caution is advised) include:

• Severe head injury
• Cardiac arrest that is not associated with trauma
• Blunt injury (for example, car accident) without any heart activity 
• Severe injury in multiple body systems
• Penetrating abdominal trauma without heart activity

Before the surgery, you will need the following preparations:

• You will be examined for your overall health and may be asked to the following tests done:
  • Blood tests: To assess the functioning of your liver and kidneys.
  • Electrocardiogram (ECG): To detect the electrical activity of the heart.
  • Methicillin-resistant Staphylococcus aureus (MRSA) screening: To prevent infection after surgery.
  • Chest X-ray: It gives information about the heart and lungs.
  • Respiratory function tests or breathing tests: To determine the function of the lungs.
  • Quantiferon blood test: To check if you have tuberculosis infection.
• You should inform your healthcare practitioner about all the medicines that you take. This includes non-prescribed medications, drugs, vitamins, herbs, and supplements. 
• If you are taking any blood-thinners like aspirin or ibuprofen, your doctor will tell you to stop taking them. 
• You will be asked to fast starting from midnight before the surgery.
• You will need someone (a friend or relative) who will take you home after the surgery.
• Try and quit smoking before the procedure to improve your recovery.
• Tell your healthcare provider if you drink more than one or two drinks in a day.
• You need to sign a consent form that gives your approval for the surgery.

The surgery is performed in the operating room. Before the surgery, an intravenous (IV) line will be inserted inside a vein in your arm or hand to give you fluids during the procedure. You will be given general anaesthesia that will keep you asleep during the surgery. A catheter will also be placed into your bladder to drain urine. The hair near the surgical area will be removed using surgical clippers.

In an open thoracotomy, the surgeon may perform the following steps:

• You will be made to lie on one side on the surgery table, and the surgeon will place your arm over your head.
• Then, the surgeon will make a cut between your two ribs near the area targeted for surgery. The incision usually begins from the front of the chest wall towards the back to the level of the armpit.
• The surgeon will then remove or separate your ribs to gain access to the area on which surgery is to be performed.
• After the procedure is complete, drainage tubes will be placed inside your chest to remove the accumulated fluid. 
• Your ribs will be closed using stitches (sutures).

A thoracoscopic procedure is done in the following way:

• The surgeon will make several cuts on your chest wall. 
• He/she will insert a special instrument with a camera (thoracoscope) and other surgical tools into your chest cavity through these cuts and perform the surgery.
• After the surgery, all the incisions will be sutured up.

This surgery takes about one to three hours. After the surgery, you can expect the following:

• The medical staff will shift you to the recovery room, and you will be given an oxygen mask to aid in recovery from anaesthesia.
• On returning to your ward, a nurse will keep monitoring your blood pressure and pulse. 
• You will be given medications and fluids through the IV line for a while.
• The urine catheter will be removed in one to three days. 
• A nurse will remove the drain tube after the fluid is completely removed.

You can go home after five to seven days of the surgery.

Once you are home, you will need to take the following care:

Wound care:

• Keep the wound area clean and dry.
• Avoid applying talcum powder, cream, or spraying deodorant to the surgical area until it has completely healed. 
• It is normal to feel itching, numbness, or tingling sensation when the wound is healing.

Bathing:

• You can either take a bath or shower, but prefer showering for the first two weeks. 
• Avoid soaking the surgical area for up to six weeks. 

Activities:

• You may be allowed to start driving after six weeks of surgery.
• You should remain active by doing small exercises like walking every day. 
• Do not perform heavy activities alone for four to six weeks.
• The doctor may advise doing breathing exercises to avoid breathlessness after the surgery. 

Diet: 

• You should drink one to two litres of liquid every day.
• Take small frequent meals until you are completely healed.

Medicines:

• You will be prescribed painkillers after the surgery. 
• Your doctor may suggest you to wear antiembolic stockings for at least six weeks to prevent blood clots in your legs.

When to see the doctor?

You should inform your healthcare provider immediately if you experience the following:

• Unexplained swelling or pain in the legs
• Worsening of pain despite taking painkillers
• Redness, warmness, or hardness around the wound 
• Constipation despite taking laxatives 
• Discharge from the wound 
• Breathlessness

The risks of this surgery are as follows:

• A blood clot in the leg
• Bleeding
• Chest or lung infection
• Infection around the wound
• Bronchopleural fistula (an open tract that forms between the bronchi and the pleural space)
• Prolonged air leak from lungs
• Prolonged pain
• Damage to surrounding organs (apart from the one being operated on)
• Respiratory failure (a condition in which your lungs are not able to properly send oxygen into your blood or remove carbon dioxide or both)

You will need to revisit your doctor after two to six weeks. The doctor will examine your wound and perform a chest X-ray to check your health.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.