Chest opening surgery or thoracotomy is a major surgical procedure used to access organs in the chest cavity, such as the lungs, heart, and esophagus. Lung cancer is one of the conditions that is often treated with this surgery.
In thoracotomy surgery, surgical incisions are made in the chest wall, and access to the organs in the chest cavity is made by cutting or sometimes removing part of the ribs. Apart from being a treatment method, this surgery can also be used to diagnose a condition or disease.
Conditions Treated by Thoracotomy
Thoracotomy may be performed for several reasons. The reason is, opening the chest cavity and the area between the right and left lungs (mediastinum) also allows doctors to access the heart, esophagus (esophagus), the top of the aorta, which is a large blood vessel that drains blood directly from the heart, and the front of the spine.
The following are some conditions or diseases that can be treated with thoracotomy surgery:
- Esophageal cancer
- Lung infection (pneumonia)
- Congenital heart disease
- Chest injury that causes bleeding in the lungs
- Pneumothorax
- Tuberculosis (TB)
- Tumors in the mediastinum
Types of Thoracotomy Surgery
Based on the conditions being treated, thoracotomy surgery is divided into several types, namely:
1. Posterolateral thoracotomy
This type is the most common chest opening surgery procedure. The goal is to treat lung cancer by removing all or part of the lung.
An incision will be made along the side of the chest towards the back between the ribs. The ribs are then stretched or raised so that the lungs can be accessed. After that, the doctor will remove the problematic part of the lung.
2. Median thoracotomy
In this surgical procedure, the doctor will make a vertical incision through the breastbone (sternum) in order to access the chest cavity. This procedure is usually done to treat heart disease.
3. Axillary thoracotomy
In an axillary terachotomi, the doctor will make an incision near the armpit (axillary) to gain access to the chest cavity. This procedure is usually done to treat pneumothorax , as well as as a supporting procedure for several other lung and heart surgeries.
4. Anterolateral thoracotomy
This procedure is an emergency procedure that involves an incision along the front of the chest. Anterolateral thoracotomy can be performed to treat severe chest injuries.
Thoracotomy Operation Process to Open the Chest Cavity
Before the operation, the doctor will perform a physical examination, medical history, and the condition of the problematic organs. If you smoke, your doctor will advise you to quit smoking a few days before surgery.
The operation is performed under general anesthesia so that you fall asleep and feel no pain during the procedure. In addition, the doctor will also place a small tube in the spine (epidural tube) to give pain medication during surgery.
The doctor will make an incision according to the type of thoracotomy surgery performed. After the incision is made, the doctor will open the muscles and, if necessary, lift the ribs so they can reach the contents of the chest cavity.
If you have lung surgery, the diseased part of the lung will be deflated with a special tube so that the doctor can perform the operation properly. While the other parts of the lung will continue to work with the help of a breathing apparatus (ventilator).
After the surgery is complete, the doctor will re-expand your lungs. Temporarily, a tube will be placed in the chest to drain fluid, blood, and air that may have accumulated in the lungs as a result of the surgery. This hose will be left in place for a few days.
Your ribs will then be repaired and the incision closed with special stitches or staples. On average, the entire thoracotomy procedure takes 2–5 hours.
For certain conditions, minimally invasive surgery (small incision or no incision) known as thoracoscopy surgery may be used instead of a thoracotomy. This procedure is carried out with the help of video ( video-assisted thoracoscopic surgery /VATS).
In a thoracoscopy, several small incisions are made in the chest and surgery is performed by inserting a pair of camera binoculars. Thoracoscopy or VATS can be used even for some relatively large procedures, such as partial lung removal.
Compared to thoracotomy, thoracoscopic surgery has several advantages, namely faster recovery after surgery and less pain after surgery. Unfortunately, this operation is not yet available in all hospitals in Indonesia.
Complications of Thoracotomy Surgery
Some complications that can occur after surgery to open the chest cavity are:
- Prolonged need for ventilation
- The need for prolonged chest tube insertion due to persistent air leakage
- Pain in the incision area that lasts a long time
- Infection
- Bleeding
- Blood clotting disorders, such as deep vein thrombosis ( deep vein thrombosis ) or pulmonary embolism
- Heart attack or arrhythmia
- Disturbance or even paralysis of the vocal cords
- Bronchopleural fistula or the formation of an abnormal pathway in the area between the bronchi (lower airways) and the space between the membranes (pleura) that line the lungs
After surgery, you usually need to be hospitalized for 4–7 days. During that time, the doctor will monitor your condition periodically. If you experience complaints at home after being allowed to go home, immediately see a doctor who treats you.
Written by:
dr. Sonny Seputra, M.Ked.Klin, Sp.B, FINACS
(Surgeon Specialist)
