Thoracotomy Lung Surgery

Physical examBlood and urine tests Imaging tests of the chest, such as x-ray, CT scan, or MRI scanPulmonary function tests to assess the capacity of your lungs to undergo surgery Assess your heart to ensure that you can withstand the surgery Check your blood and see if you are maintaining adequate oxygenation and excretion of carbon dioxide To minimize your complications, you must stop smoking at least 2 to 3 weeks before surgeryUndergo pulmonary rehabilitation to exercise your lungs The day before and the day of surgery: Use an enema to clear your colon so that your abdomen does not become distended during surgery.Do not eat or drink anything after midnight.Your doctor may recommend a sleeping pill so that you'll get adequate rest the night before the surgery.Before going to the hospital, remove all jewelry, contact lenses, dentures, wigs, and nail polish. During ProcedureAnesthesia and pain medication will be administered. AnesthesiaGeneral anesthesia will be given. You may also be given pain medication through a spinal/epidural (a thin tube placed along the spinal column in your back). Description of the ProcedureFor a thoracotomy, you will be placed on your side with your arm elevated. The doctor makes an incision between two ribs from front to back. The chest wall is opened, which provides access to the lungs. The doctor removes the tissue and/or tumor from the lungs, or works with other structures in the chest as necessary. To make sure that your lungs stay inflated and that there is no collection of blood or air in the chest, the surgeon will place one or more catheters (chest tubes). These catheters are brought out onto the skin and will be hooked up to a suction bottle.

There are three main approaches to thoracotomy: Median sternotomyThis approach involves the surgeon making a vertical incision along the sternum, and then dividing the sternum to gain access to the heart and lungs. Most open-heart surgeries use this procedure. Posterolateral thoracotomyThis is the traditional approach for operations on the lungs. An incision is often made in the bed of the 5th rib (5th intercostals space), which allows the surgeon to access the pulmonary artery and pulmonary vein. Anterolateral thoracotomy A large surgical incision that is made on the anterior chest wall. Left anterolateral thoracotomy may be used after cardiac arrest to perform open chest massage. Video-Assisted Thoracic Surgery (VATS) VATS is a less invasive alternative than the previously described open procedures. The surgeon can perform VATS in select cases, and is also able to diagnose and observe from within the chest cavity (avoiding a large incision and thus decreasing pain after the operation). Left Lung Mass With Thoracotomy 2008 Nucleus Medical Art, Inc. After Procedure The incision is closed with stitches or staples, and bandaged to prevent infection. You will be sent to the intensive care unit for recovery. After surgery, you will have numerous intravenous lines and tubes in and around your body. As you improve and eat and walk, most of these will be removed. You will have several catheters that include:

Urinary catheter to measure urine output and avoid the need to urinate in the bathroom Endotracheal tube in the trachea to assist breathing A machine called a ventilator, which is usually connected to an endotracheal tube, that can breathe for youChest tube to remove air, blood, or fluid from the pleural spaceNasogastric tube, which is inserted through the nose and into the stomach, to remove stomach secretionsYou may be given antibiotics, pain medication, or antinausea drugs after surgery. How Long Will It Take?The surgery typically takes 3 to 4 hours. Will It Hurt?Anesthesia prevents pain during the procedure. You may have some discomfort after the surgery. Possible ComplicationsBleeding in the lung cavity (hemothorax)Infection on the skin woundInfection inside the chest cavityPersistent pain (only in a few cases)Reaction to anesthesiaFailure to completely expand the lungContinued drainage from the chest tubes Collection of air or gases in the lung cavity (pneumothorax) Average Hospital StayThe hospital stay is typically 5 to 10 days. Postoperative Care Once you leave the hospital: Do coughing and deep breathing exercises as instructed by the nurse or physical therapist 3 to 4 times daily to help keep your lungs clear.Get out of bed often and sit in a chair. Increase your activity as much as tolerated.Stay well-hydrated.Do not smoke.Avoid environments that expose you to germs, smoke, or chemical irritants. OutcomeThe outcome will depend on the reason for the procedure.

Call Your Doctor If Any of the Following OccursDifficulty breathingNew pain in the chestStitches or staples come apartBandage becomes soaked with bloodCough up mucus that is yellow, green, or bloodySigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge at the incision siteCough, shortness of breath, chest pain, or severe nausea or vomitingPain, burning, urgency or frequency of urination, or persistent bleeding in the urine RESOURCES: American Thoracic Societyhttp://www.thoracic.org/ Society of Thoracic Surgeonshttp://www.sts.org/ CANADIAN RESOURCES: Canadian Society for Vascular Surgeryhttp://csvs.vascularweb.org/ The Lung Associationhttp://www.lung.ca/ References: Athanassiadi K, Kakaris S, Theakos N, Skottis I. Muscle-sparing versus posterolateral thoracotomy: a prospective study. Eur J Cardiothorac Surg. 2007;31:496-500. Medical encyclopedia: lung surgery. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002956.htm. Accessed October 14, 2005. Ohbuchi T, Morikawa T, Takeuchi E, Kato H. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg. 1998 Jun;46(6):519-22.

Saint Mary's Hospital, Saginaw website. Available at: http://www.hospitalsoup.com/rn/asp/HospitalID.11842/pt/hospitaldetails3.asp. Accessed October 14, 2005. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/videoassistedthoracoscopicsurgery.html. Accessed June 15, 2007. Last reviewed May 2008 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.