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
Lobectomy
Pneumonectomy
Both lobectomy and pneumonectomy are done most commonly to treat lung cancer Lung Carcinoma Lung carcinoma is the leading cause of cancer-related death in men and women worldwide. About 85% of cases are related to cigarette smoking. Symptoms can include cough, chest discomfort or pain... read more .
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 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