Thoracotomy: indications, performance, types and approaches, postoperative period. opening of the neck, chest and abdomen Thoracotomy surgical technique

Thoracotomy is considered one of the most traumatic surgical interventions. It involves opening the chest to gain access to the organs of the mediastinum and thoracic cavity.

Thoracotomy is required for a variety of diseases of the lungs, pleura, esophagus, mediastinal organs - tumors, tuberculosis, suppurative processes, injuries that cannot be cured by conservative methods. The operation can be emergency or planned, diagnostic and therapeutic, and often a diagnostic thoracotomy “grows” into a therapeutic one.

Most often, surgeons in oncology hospitals and phthisiology departments resort to thoracotomy due to the high prevalence of tumor pathology and tuberculosis. Patients are usually adults, but children may also need such surgery.

For successful thoracotomy, careful preparation of the patient, assessment of all possible risks and elimination of causes that can lead to serious complications in the postoperative period are very important.

Indications and contraindications for thoracotomy and its types

Indications for thoracotomy include a large number of diseases of the chest and mediastinal organs. Among them:

Heart failure; Valvular pneumothorax; Massive bleeding into the chest cavity; Injuries of the heart and large vascular trunks; Cardiac tamponade; Large foreign bodies in the bronchi or trachea; Purulent inflammation of the pleura; Tumors and cysts of the lungs, pleura, pericardium, heart, esophagus; Tuberculosis.

In case of injuries and life-threatening conditions, thoracotomy is performed on an emergency or urgent basis. Tumors that are not complicated by massive bleeding, large cysts and scars, and tuberculosis are treated mainly as planned.

Diagnostic thoracotomy (exploratory) is performed for the following purposes:

Clarification of the nature of the volumetric process (tumor, cyst); Clarification of the degree of spread of the pathological process to neighboring organs and tissues relative to the primary focus, when other non-invasive diagnostic methods do not allow this; Determining the effectiveness of previous treatment if laboratory data or results of instrumental studies are insufficient; Tissue sampling for histological examination (biopsy).

When planning exploratory thoracotomy of the chest, the surgeon is prepared for a possible expansion of the scope of the operation. Having discovered a tumor that can be excised from this access, the doctor will remove it, and the operation will move from diagnostic to therapeutic.

There are also contraindications to thoracotomy. In general, they are similar to those for other major interventions: severe bleeding disorders, decompensated pathology of the respiratory and cardiovascular systems, kidneys, liver, when general anesthesia and surgical trauma are fraught with serious complications, inoperable tumors that can no longer be eliminated surgically, acute infectious pathology.

Thoracotomy is far from a safe procedure, the risk of complications is still high, but it can be reduced by clearly defining the indications, the appropriateness of the intervention, prescribing antibiotics for the prevention and treatment of infectious complications, as well as choosing the optimal access that minimizes trauma and shortens the path to pathological changes tissues.

Depending on the timing of the thoracotomy operation, it can be:

Emergency - carried out for health reasons as quickly as possible upon admission of the patient to the hospital (cardiac tamponade, vascular injuries, etc.); Urgent - indicated no later than the first day from the moment the pathology is detected (pneumothorax, bleeding that cannot be eliminated conservatively); Delayed - in the first 3-5 days from the onset of the disease or the moment of injury (recurrence of pneumothorax or bleeding, threat of re-bleeding); Planned - depending on the disease and condition of the patient, it is prescribed after adequate preparation; it is indicated when there is no immediate threat to life at the moment (tuberculosis, tumor, cyst).

The purpose of the operation implies the identification of two types of thoracotomy:

Exploratory (trial) - diagnostic operation; Therapeutic - carried out deliberately for therapeutic purposes when an accurate diagnosis has been established.

Exploratory thoracotomy is the final stage of the diagnostic search, a necessary measure when the doctor has to state the ineffectiveness of all possible other methods of diagnosing the pathology. Today, they are trying to perform this operation less and less, using the most modern research methods, because the risk of death even with a trial thoracotomy reaches, according to some data, 9%, and with an open therapeutic thoracotomy it is even higher.

Preoperative preparation

In preparation for a planned thoracotomy, the patient undergoes a thorough examination, including:

pleural tumor on x-ray

General blood and urine analysis;

Biochemical blood test, determination of group and Rh affiliation; Coagulability study; Chest X-ray, CT, MRI; Determination of external respiration function; ECG; Examinations for hepatitis, HIV, syphilis.

The attending physician must be notified of all medications the patient is taking; aspirin and other blood thinners are discontinued. Antihypertensives, beta blockers, and bronchodilators are taken as usual.

On the eve of the intervention, a cleansing enema is performed (if general anesthesia is planned); food and water intake is excluded at least 12 hours before the operation. In the evening, the patient takes a shower and changes into clean clothes.

The most important stage of preparation for lung surgery is training the heart and respiratory system. To carry it out, dosed walking is recommended for a distance of up to 3 km. Complete smoking cessation is required several weeks before thoracotomy.

If there is a high risk of pulmonary complications, stimulated spirometry is performed. In case of inflammatory processes, antibiotic therapy is prescribed in the preoperative period. If, due to the underlying disease, the patient takes glucocorticosteroids, their dosage is reduced to a minimum before surgery, since hormones impair the healing of the postoperative wound.

Thoracotomy requires general anesthesia with one-lung ventilation. In rare cases, local infiltration anesthesia is used. On average, the operation lasts about three hours, but possibly longer.

Surgical approaches and thoracotomy techniques

Success in thoracotomy interventions depends on the correctness of the chosen access and strict adherence to the stages of the operation and the surgical technique of thoracotomy. Thoracotomy is performed by highly qualified specialists with considerable experience in this field of surgery.

To reach the lung, mediastinum, and vessels during thoracotomy, a minimal path to pathologically altered tissues is necessary, but at the same time, access must be sufficient for good orientation, performing surgery on internal organs and overcoming obstacles in the event of unforeseen circumstances.

Approaches used for thoracotomy:

Anterolateral, when the patient lies on his back. Lateral position on the healthy side. Posterolateral, in which the patient is placed on his stomach.

The anterolateral approach is considered technically simple and the least traumatic. which is used quite often. It is indicated for interventions on the lung, diaphragm, lower third of the esophagus, and heart.

The patient is placed on his back with the painful side slightly elevated; this position ensures the correct functioning of the myocardium and the second lung, therefore it is considered the most physiological among all types of access. Other advantages of this type of thoracotomy include the convenience of isolating the main bronchus and the minimal likelihood of contents entering the opposite bronchus on the healthy side.

The disadvantage of the anterolateral incision is the difficulty in extracting tissue and mediastinal lymphatic collectors, which becomes necessary when diagnosed with lung cancer, as well as the difficulty of penetrating the middle and posterior mediastinum, and difficulties in suturing the wound.

thoracotomy from the anterolateral approach

Stages of anterolateral thoracotomy:

The patient is placed on his back, a cushion is placed under the operated side of the chest, and the arm is fixed behind the patient's head. Stepping back a little from the parasternal line, they begin the incision in the projection of the third rib, lead it in an arcuate manner below the nipple outward, to the posterior axillary line, where it is at the level of 4-5 ribs. In women, two centimeters extend downwards from the fold of the mammary gland. Dissection of the skin and subcutaneous layer, fascia of the chest wall, areas of the pectoralis major muscle, the attachment zone of the serratus anterior muscle with delamination of its fibers, the latissimus dorsi muscle is retracted upward. In the desired intercostal space, the muscles are dissected along the upper edge of the underlying rib in order to avoid injury to the intercostal arteries, then the external pleural layer is dissected in the area between the anterior axillary and midclavicular lines, but possibly further, outward. A retractor is placed into the resulting hole and its width is increased, after which the path to the chest organs and mediastinum is open.

Indications for anterolateral thoracotomy are diseases in which it is necessary to remove the entire lung or its individual lobes (tuberculosis, tumors, cysts, abscesses, emphysematous bullae).

lateral thoracotomy

Advantages of lateral thoracotomy It is considered possible to examine not only the organs of the anterior part of the chest, but also the posterior fragments of the lungs, heart, diaphragm, and perform the necessary surgical manipulations on them, therefore many thoracic surgeons prefer to use the lateral route to open the thoracic cavity.

Indications for lateral thoracotomy are considered to be a variety of lesions of the lungs, diaphragm, mediastinum, ranging from inflammatory processes, tuberculosis and ending with cancer. This access provides the most complete overview and sufficient space for a variety of manipulations.

The main disadvantage of the lateral approach is the possibility of the contents of the bronchial tree flowing from the diseased side to the healthy side, therefore, to prevent complications, separate intubation of the respiratory tract is performed.

To perform a lateral approach, the patient is placed on the healthy side, the arm on the side of the incision is raised up and slightly forward, and a cushion is placed under the chest. Stepping back a couple of centimeters from the parasternal line, in the projection of the 5th or 6th intercostal space, the incision begins, bringing it to the scapular line.

The incision of the skin and subcutaneous tissue, muscle bundles, and fascia is made in the same way as occurs with the anterolateral approach. When planning manipulations on the aorta, esophagus, posterior mediastinum, the latissimus dorsi muscle can be dissected in an area that will allow the surgeon to get as close as possible to the organ being operated on.

After dissecting all the tissues that make up the chest wall, napkins are applied to the edges of the wound and retractors are installed, then the ribs are slowly and carefully moved apart to create the required size of the hole in the chest wall. If there are dense adhesions in the pleural cavity, they are cut with scissors. In rare cases, surgeons resort to additional dissection of the costal cartilages to widen the wound.

Posterolateral thoracotomy

Posterolateral thoracotomy is used less frequently than other approaches, since it requires dissection of a significant mass of muscle tissue of the back and intersection of the ribs, therefore it is the most traumatic, which is considered its main disadvantage. Indications for it are strictly limited to cases where access to the required organ is impossible or difficult from other parts of the chest.

Posterolateral thoracotomy is indicated for interventions on the heart and great vessels (patent ductus arteriosus, removal of the posterior segments of the lungs, operations on the lower third of the trachea and in the area of its branching). The advantages of this approach include the possibility of manipulation of the bronchi, combining resection of the chest wall with plastic surgery, without changing the position of the person being operated on.

With the posterolateral approach, the patient lies on his stomach, the hand is placed to the side and forward, a cushion is placed under the chest on the side of the operation so that this half of the chest is higher, thus the surgeon gains access to the back and side of the chest. In the projection of the spinous processes of the 3-4 thoracic vertebrae, the incision begins in the direction of the scapular angle in an arcuate manner, then in the projection of the 6th ribs to the anterior axillary line.

After dissecting the skin and fiber, cut the muscle fibers that are on the path of penetration into the chest cavity, open the pleural layer, resect the 6th rib, and cross the necks of the 5th and 7th ribs. The resulting wound expands, and the surgeon examines and manipulates the lungs, aorta, esophagus, and posterior mediastinum.

During the operation, the vessels are sequentially sutured, the pleural cavity is cleaned of blood, pus, and adhesions during thoracotomy, and after the planned volume of intervention is completed, the tissues are sutured in the reverse order, and drainage tubes are installed in the chest cavity.

Stages of a trial (exploratory) thoracotomy:

Dissection of the tissues of the chest wall from the selected optimal access. Examination of the organs of the mediastinum and thoracic cavity, blood vessels, diaphragm, lymph nodes and determination of the nature and extent of their damage. Tissue biopsy from the pathological focus (possibly with urgent cytological and histological examination before the end of the intervention). Therapeutic manipulations - removal of tumors, blood, effusion from the pleural cavity, etc.

Video: example of emergency thoracotomy and pericardiotomy

Postoperative period and rehabilitation

In the postoperative period, the patient is prescribed antibiotics, anti-inflammatory and painkillers. By 10-14 days, the sutures are removed, drainage from the chest cavity is removed earlier.

During the entire rehabilitation phase, the patient will have to perform physical therapy exercises to restore lung function. You should not suppress your cough, because it is aimed at cleansing the bronchial tree.

One of the main problems of the postoperative period is pain relief after thoracotomy, which can last for several days or weeks, and sometimes for months and years. It is associated with a large tissue incision, possible damage to nerve endings, scarring during the healing process, etc.

For pain relief, specialists use narcotic (promedol, morphine) and non-narcotic (ketorol, paracetamol) analgesics, conduct novocaine blockades, and prolonged epidural anesthesia is possible to reduce the intensity of pain.

If the pain after thoracotomy is tolerable, then after discharge home, patients can relieve them on their own, remembering that excessive zeal can be fraught with side effects of analgesics, which are best not to be abused. It is possible to take analgin, ketorol, paracetamol, non-steroidal anti-inflammatory drugs (diclofenac, nimesulide, movalis).

Complications after thoracotomy occur in approximately 10-12% of cases, which cannot be considered such a low rate. Every tenth patient may experience bleeding, suppuration of a postoperative wound, prolonged pain, and damage to the chest organs during surgery.

To reduce the likelihood of adverse consequences, careful preparation for the operation is required, an assessment of the risks and indications for it, strict adherence by the surgeon to the operating technique and the correct choice of access and surgical option.

Thoracotomy

(from ancient Greek θώραξ - chest and τομή - incision, dissection) - a surgical operation consisting of opening the chest through the chest wall to examine the contents of the pleural cavity or perform surgical interventions on the lungs, heart or other organs located in the chest (Fig. 1). It is one of the thoracic approaches in thoracic surgery, providing for penetration into the chest organs through the chest wall (as opposed to extrathoracic and combined approaches).

1 Types of thoracotomy 1.1 Anterolateral thoracotomy 1.2 Posterolateral thoracotomy 1.3 Lateral thoracotomy 1.4 Axillary thoracotomy 1.5 Parasternal thoracotomy 2 Complications 3 See also 4 Notes 5 Literature 6 References

Types of thoracotomy

Anterolateral thoracotomy

Convenient with wide access to the anterior surface of the lung and the vessels of the lung root.

Position of the patient on the table: On the back with the sore side raised; the arm of the affected side is bent at the elbow joint and fixed above the patient’s head.

Technique: The incision is made along the 5th rib from the edge of the sternum to the mid-axillary line, the latissimus dorsi muscle is retracted outward. The pleural cavity is opened in the IV or V intercostal space: the tissues of the intercostal space are dissected along the entire length of the skin wound. If it is necessary to expand access, the overlying (III or IV) costal cartilages are intersected.

Application: Right and left pneumonectomy, removal of the upper and middle lobe of the right lung.

Advantages: Low trauma, convenient position of the patient's body for anesthesia and surgery, prevention of bronchial contents from entering the opposite lung, convenience of isolating the main bronchus and removing tracheobronchial lymph nodes.

Disadvantages: Only the anterior mediastinum is accessible, difficulties in suturing and sealing the wound.

Posterolateral thoracotomy

Rarely used

Position of the patient on the table: On the stomach.

Technique: An incision is made between the inner edge of the shoulder blade and the spine. The trapezius and both rhomboid muscles are dissected. The angle of the scapula curves around to the midaxillary line (to the edge of the pectoralis major muscle). A subperiosteal resection of the VI rib is performed, and the necks of the V and VII ribs are resected.

Application: Patent ductus arteriosus (during surgical treatment). Resection of the posterior portions of the lung, mobilization of the lower trachea and its bifurcation, including the contralateral main bronchus, pneumonectomy with circular resection of the tracheal bifurcation.

Advantages: Convenient for intervention on the bronchial tree; it is possible to combine extensive resection of the chest wall with thoracoplasty without changing the patient’s body position.

Disadvantages: Highly traumatic.

Left lateral thoracotomy. Position of the patient on the table Left-sided lateral thoracotomy. Skin incision Left lateral thoracotomy. The ribs are separated by a retractor

Lateral thoracotomy

Is the most common.

Position of the patient on the table: On the healthy side, under which a cushion is placed at the level of the pectoralis major muscle (at the level of the breast in women). The arm on the side of the operation is bent at the elbow joint and abducted upward and to the side, fixed above the patient’s head. The pelvic girdle is in a lateral position (Fig. 2).

Technique: Skin incision along the 5th rib from the angle of the scapula or posterior axillary line, below and 2-3 cm inward from the nipple (in women, going around the mammary gland from below) to the midclavicular line (Fig. 3). The latissimus dorsi muscle is dissected only 3-4 cm. The muscle fibers of the serratus anterior muscle are bluntly separated. The intercostal muscles are dissected along the anterior surface of the chest, and posteriorly from the anterior axillary line, they are torn with a finger to the heads of the ribs (such a division is also possible along the anterior surface to the sternum). The pleural cavity is opened in the 5th intercostal space (Fig. 4).

Application: Various operations on the lungs, regardless of the location of the pathological process, as well as operations on the mediastinal organs and diaphragm.

Advantages: Low-traumatic. Allows you to approach any anatomical formation of the pleural cavity and mediastinum. Creates good conditions for manipulation in all parts of the pleural cavity.

Disadvantages: Danger of bronchial contents entering the opposite lung in the absence of separate intubation.

Axillary thoracotomy

Refers to minimally invasive approaches.

Position of the patient on the table: On the side. The arm on the side of the operation is bent at the elbow joint and abducted upward and to the side, fixed above the patient’s head so that the axillary area is well accessible.

Technique: Incision from the edge of the latissimus dorsi muscle from top to bottom in an oblique direction to the lateral edge of the pectoralis major muscle. The serratus anterior muscle is cut or separated. The pleural cavity is opened in the IV or V intercostal space.

Application: Minor surgical interventions on the surface of the lung.

Advantages: Absence of a large muscle mass in the incision area, low visibility of the postoperative scar.

Disadvantages: Impossibility of approaching the root of the lung.

Parasternal thoracotomy

Position of the patient on the table: On the back with a cushion placed along the spine with an indentation of 3-5 cm on the operated side.

Technique: An incision parallel and 3 cm lateral to the edge of the sternum, 6 cm long, followed by subperichondral resection of 2 (or more) costal cartilages over a length of 2-3 cm. The internal mammary artery and vein are retracted medially. The exposed pleura is retracted laterally or, if necessary, opened.

Application: Parasternal biopsy, mediastinoscopy, revision and biopsy of mediastinal tumors.

Disadvantages: Possibility of revision of the mediastinum only on one side.

Complications

Complications after thoracotomy occur in 6-12% of cases. The main ones are:

pain syndrome; suppuration of a postoperative wound; bleeding.

Notes

1 2 3 4 Trakhtenberg A. Kh., Chissov V. I. Clinical oncopulmonology. - M.: GEOTAR MEDICINE, 2000. - P. 266-269. - 600 s. - 1500 copies. - ISBN 5-9231-0017-7. 1 2 3 4 5 Vishnevsky A. A., Rudakov S. S., Milanov N. O. Chest wall surgery: Guide. - M.: Vidar, 2005. - P. 268-286. - 312 s. - 1000 copies. - ISBN 5-88429-085-3.

Literature

Vishnevsky A. A., Rudakov S. S., Milanov N. O. Chest wall surgery: Guide. - M.: Vidar, 2005. - P. 268-286. - 312 s. - 1000 copies. - ISBN 5-88429-085-3. Trakhtenberg A. Kh., Chissov V. I. Clinical oncopulmonology. - M.: GEOTAR MEDICINE, 2000. - P. 266-269. - 600 s. - 1500 copies. - ISBN 5-9231-0017-7. Ferguson M.K. Atlas of Thoracic Surgery. - M.: GEOTAR-Media, 2009. - P. 14-31. - ISBN 978-5-9704-1021-9.

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Thoracotomy — operational access to the organs of the chest cavity by layer-by-layer dissection of the chest wall.

Access to the organs of the thoracic cavity is divided into two groups (Fig. 17.7, 17.8):

Rice. 17.7. Operative access to the lung:

a — anterolateral thoracotomy; b — lateral thoracotomy; c — posterolateral thoracotomy

Rice. 17.8. Operative access to the heart:

a, b — anterior left-sided approaches; c — longitudinal sternotomy; d — transbipleural access

1) transpleural thoracotomy - access to the pleural cavity to the lung, as well as through the pleural cavity to the mediastinal organs;

2) extrapleural thoracotomy (extrapleural) - access to the mediastinal organs without dissecting the pleura.

Both right- and left-sided transpleural thoracotomy is performed with dissection of the intercostal space; if necessary, rib resection or intersection of adjacent ribs is performed.

Methods of transpleural thoracotomy:

Anterolateral (upper, middle, lower);

Posterolateral (middle, lower); lateral;

Transbipleural access with transverse sternotomy (Bakulev-Meshalkin access).

Extrapleural thoracotomy:

Longitudinal sternotomy (transsternal) is a surgical approach to the organs of the anterior mediastinum and great vessels, during which the sternum is dissected. There are complete longitudinal, partially longitudinal, longitudinal-transverse and transverse sternotomy;

Paraspinal extrapleural thoracotomy according to I.I. Nasilov, G.A. Bairov.

Main approaches to the organs of the thoracic cavity:

Anterolateral thoracotomy;

Lateral thoracotomy;

Posterolateral thoracotomy;

Longitudinal sternotomy;

Transbipleural approach with transverse sternotomy. Anterolateral and posterolateral approaches have their own characteristics, advantages and disadvantages.

The least traumatic for the muscles of the chest wall is the anterolateral thoracotomy, in which the vastus dorsi muscles are not crossed. The anterolateral approach is the most cosmetic, especially for women. With the anterolateral approach, the functions of the second lung and the cardiovascular system are least disrupted, since during the operation the mediastinum shifts slightly to the healthy side. When the patient lies on his back, the possibility of sputum flowing into the bronchial tree of this lung is reduced, which facilitates anesthesia.

The anterolateral approach is less traumatic and provides wide access to the vessels of the lung root. The incision allows sufficient access

to all parts of the lung. This approach provides the best opportunity to enter the chest cavity and navigate in the presence of adhesions of the visceral and parietal pleura in the posterolateral parts of the chest cavity and along the diaphragm.

Anterolateral thoracotomy according to P.A. Kupriyanov

Anesthesia: anesthesia

Patient position: lying on your back with a cushion placed on the side of the operation. The patient's arm on the side of the operation is fixed so that the shoulder is located at a right angle.

Execution technique. The incision begins at the level of the third rib, slightly outward from the parasternal line, is lowered along an arc to the projection of the fourth intercostal space and carried out to the middle or posterior axillary line. In the vertical part of the incision, you should step back slightly outward from the parasternal line and cross the fibers of the sternal part of the pectoralis major muscle in such a way that then, when suturing the wound, you will have enough muscle tissue to apply a second row of sutures. In women, the incision is made under the mammary gland, 2 cm from the lower fold. The mammary gland is retracted upward. The horizontal part of the incision is made along the upper edge of the 5th rib to avoid damage to the intercostal vessels.

By dissecting the skin, subcutaneous tissue and superficial fascia, the substernal and costal fibers of the pectoralis major muscle are dissected; in the posterior part of the incision, the attachment of the serratus anterior muscle is cut off (m. serratus anterior) and then push its fibers apart. In the posterior part of the incision, the anterior edge is retracted outward m. latissimus dorsi. After dissection of the intercostal muscles, dissect fascia endothoracica and parietal pleura. In the medial corner of the wound, one must beware of damage a. thoracica interna. To prevent this, it is necessary to make the incision under the control of a finger, not extending 2-3 cm to the edge of the sternum. After opening the pleural cavity, a retractor is inserted into the wound. If necessary, rib resection or intersection of two adjacent ribs is performed.

Thoracotomy (Lung Surgery; Surgery, Lung)

Description

Thoracotomy is an operation to open the chest wall. The operation allows access to the lungs, throat, aorta, heart and diaphragm. Depending on the surgical site, a thoracotomy may be performed on the right or left side of the chest. Sometimes a small thoracotomy may be done on the front of the chest.

Reasons for performing a thoracotomy

A thoracotomy may be done to:

Confirm the diagnosis of lung or chest disease; Perform surgery on the heart or blood vessels of the lungs and heart; Treat tracheal disorders; Remove part or all of a lung; Treat esophageal disorders; Remove lung tissue that has collapsed due to disease or injury; Remove pus from the chest; Remove blood clots from the chest.

Possible complications of thoracotomy

If a thoracotomy is planned, you need to be aware of possible complications, which may include:

Bleeding; Infection; Damage to organs in the chest; Persistent pain (in some cases); Reaction to anesthesia; Accumulation of air or gases in the chest.

Factors that may increase the risk of complications:

Extensive injury involving many parts of the body; Age; Smoking; Previous stroke or heart attack; Previous radiation therapy; Chronic health problems.

How is a thoracotomy performed?

Preparation for the procedure

The doctor may prescribe:

Medical checkup; Blood and urine tests; X-ray, computed tomography or MRI of the chest; Lung function tests to see how well they are working; Heart function tests.

In anticipation of the operation:

Consult your doctor about any medications you are taking. A week before surgery, you may need to stop taking certain medications: Aspirin or other anti-inflammatory drugs; blood thinners such as clopidogrel (Plavix) or warfarin; You may be asked to use an enema to cleanse your bowels; Do not eat or drink the night before surgery; To minimize complications, you should stop smoking at least 2-3 weeks before surgery.

Anesthesia

The operation is performed under general anesthesia, and the patient sleeps during the operation.

Description of the thoracotomy procedure

You will lie on your side with your arms raised. An incision will be made between the two ribs along the entire length. The chest wall will be open. In some cases, the doctor may use a different method.

The doctor performs the necessary operation with the chest open. After the surgery is completed, one or more drainage tubes will be placed in the chest to prevent blood and air from building up in the chest. The chest will be closed. The incision will be closed with stitches or staples and bandaged to prevent infection.

Immediately after thoracotomy

You will be admitted to the intensive care unit for recovery and observation.

How long will a thoracotomy take?

The duration of the operation is 3-4 hours or more.

Thoracotomy - will it hurt?

Anesthesia prevents pain during the procedure. You may experience some discomfort after surgery. Your doctor will give you medicine to help reduce painful symptoms.

In some cases, thoracotomy can lead to chronic pain, which is usually felt as a burning pain in the surgical area. This may be due to increased sensitivity to touch in this area. The pain usually improves over time, but you may need professional help if the pain persists.

Average hospital stay after thoracotomy

Typically the length of hospital stay is 5-10 days. If complications arise, your hospital stay may be extended.

Care after thoracotomy

Hospital care

After surgery, catheters and tubes will be placed in the body. Most of them will be removed after restoration. They help you urinate, breathe, and provide nutrition through them. You may be prescribed antibiotics, pain relievers, or anti-nausea medications; Cough frequently and do deep breathing exercises. This will help keep your lungs clean; Get out of bed and start sitting in a chair. Increase physical activity as you recover.

Home care

When you return home, follow these steps to ensure a normal recovery:

Ask your doctor when it is safe to shower, swim, or expose the surgical site to water; Drink plenty of fluids; Do not smoke; Avoid environments that expose you to germs, smoke or chemical irritants; Be sure to follow your doctor's instructions.

Contacting your doctor after a thoracotomy

After returning home, you should consult a doctor if the following symptoms appear:

difficulty breathing or cough; new chest pain or persistent and severe pain in the surgical area; Sutures or staples are coming apart; The bandages are soaked in blood; Cough with mucus that is yellow, green, or bloody; Signs of infection, including fever and chills; Redness, swelling, increased pain, bleeding, or discharge from the incision; Severe nausea and vomiting; Pain, burning, frequent urination, or constant bleeding in the urine.

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thoracotomy
Thoracotomy(from ancient Greek θώραξ - chest and τομή - incision, dissection) - a surgical operation consisting of opening the chest through the chest wall to examine the contents of the pleural cavity or perform surgical interventions on the lungs, heart or other organs located in the chest (Fig. 1). It is one of the thoracic approaches in thoracic surgery, providing for penetration into the chest organs through the chest wall (as opposed to extrathoracic and combined approaches).

1 Types of thoracotomy
- 1.1 Anterolateral thoracotomy
- 1.2 Posterolateral thoracotomy
- 1.3 Lateral thoracotomy
- 1.4 Axillary thoracotomy
- 1.5 Parasternal thoracotomy
2 Complications
3 See also
4 Notes
5 Literature
6 Links