Thoracotomy

Thoracotomy is a surgical incision between the ribs that allows the surgeon to directly view your lung, esophagus and the area around it. Typical procedures done thru that incision include removal of 1) Lung or portions of a lung 2) Esophagus 3) Other chest tumors 4) Repair of the esophagus, lungs or blood vessels. Most of the issues related to recovery (pain control, wound care, limited activity, etc) are related to the incision.

Before Surgery

Do not drink anything, including water, after midnight the night before the procedure. If you are taking aspirin or other blood thinners, please stop these medications 7 days before your procedure. You may take your other medications with only sips of water the morning of the procedure unless instructed otherwise by your physician.

Procedure

The thoracotomy incision is done in the operating room under general anesthesia. General anesthesia causes you to be asleep and unconscious during the procedure and is administered by an anesthesiologist. After the anesthetic takes effect the anesthesiologist places a breathing tube. This tube is removed at the end of the operation.

Once you are asleep, you are positioned comfortably on your side and covered with a sterile drape. Your surgeon then makes an incision across your side in between the ribs.

When the procedure is finished, a tube is placed in the chest temporarily to drain fluid and air. Once you are awake in the Operating Room, you will be taken to the Recovery Room. Often procedures involving thoracotomy may take 3-4 hours. Your family and/or significant others will be in the surgery waiting room and will be kept informed of your progress during and after the procedure.

Once leaving the Recovery Room, you may be transferred to the Intensive Care Unit on the 2nd floor or the Cardiovascular Unit on the 3rd floor. Generally, you will be discharged after 3-7 days.

Possible Risks or Complications

  1. Pneumonia can occur due to poor pain control and/or a lack of activity. Getting out of bed and walking on the days right after surgery is very important.
  2. For lung surgery, air leaks from the suture line on your lung may take a few days to heal. This requires the chest tube to stay in place. In rare cases patients may go home with a chest tube.
  3. Bleeding is a risk with any operation, but significant bleeding requiring a blood transfusion with this operation is rare.
  4. Wound infection can occur with any surgical incision. Intravenous antibiotics are given immediately before and after surgery in the hospital as a preventative measure.

Pain Management

Prior to surgery; in the preoperative holding area, the anesthesiologist may place an epidural catheter with your permission. The epidural, similar to the type used during childbirth, is used for pain control immediately following surgery. Epidural medications can be constipating or cause urinary retention, so a bladder catheter (foley) is placed to help drain your urine while the epidural is in place.

Oral pain medication will be prescribed immediately after the epidural catheter is discontinued. This oral pain medication will be prescribed so that you can go home on it. This medication can cause nausea in some patients, so it may be helpful to take it with food. Also, narcotics can be constipating, so a stool softener is recommended during your recovery period. Tylenol or Ibuprofen also may relieve the discomfort if you are unable to tolerate narcotics.

Follow Up

An appointment will be made for you to be seen in the office 1-2 weeks after discharge from the hospital to check the incision and to assess your activity level and pain control. Notify the office if you experience:

  • Fever over 100.5 F
  • Worsening shortness of breath
  • Uncontrolled pain
  • Redness or drainage from your incision site