Thoracotomy Lung Surgery

Prior to Procedure

Your doctor will likely do some or all of the following:

• Physical exam
• Blood and urine tests
• Imaging tests of the chest, such as x-ray, CT scan, or MRI scan
• Pulmonary 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 surgery
• Undergo pulmonary rehabilitation to exercise your lungs

During Procedure

Anesthesia and pain medication will be administered.

Anesthesia

General 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 Procedure

For 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:

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 you
• Chest tube to remove air, blood, or fluid from the pleural space
• Nasogastric tube, which is inserted through the nose and into the stomach, to remove stomach secretions

You 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 Complications

• Bleeding in the lung cavity (hemothorax)
• Infection on the skin wound
• Infection inside the chest cavity
• Persistent pain (only in a few cases)
• Reaction to anesthesia
• Failure to completely expand the lung
• Continued drainage from the chest tubes
• Collection of air or gases in the lung cavity (pneumothorax)

Average Hospital Stay

The 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.