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Thoracotomy

A thoracotomy is a surgical procedure that allows access to the pleural space and thoracic organs, commonly performed for lung cancer surgeries or major trauma. Various approaches include the posterolateral and anterolateral thoracotomies, each providing specific advantages for exposure. Complications can include pneumothorax, infection, and significant postoperative pain, often managed with opioid analgesics and nerve blocks.

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14 views1 page

Thoracotomy

A thoracotomy is a surgical procedure that allows access to the pleural space and thoracic organs, commonly performed for lung cancer surgeries or major trauma. Various approaches include the posterolateral and anterolateral thoracotomies, each providing specific advantages for exposure. Complications can include pneumothorax, infection, and significant postoperative pain, often managed with opioid analgesics and nerve blocks.

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Roshan raj
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Thoracotomy

A thoracotomy is a surgical procedure to gain access into the pleural space of the chest.[1] to
gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or
for access to the thoracic aorta or the anterior spine (the latter may be necessary to access
tumors in the spine). A thoracotomy is the first step in thoracic
surgeries including lobectomy or pneumonectomy for lung cancer or to gain thoracic access
in major trauma.

Approaches[edit]
There are many different surgical approaches to performing a thoracotomy. Some common
forms of thoracotomies include:

 Posterolateral thoracotomy is the most common and traditional approach for gaining
access to the chest. It is an incision through an intercostal space on the back, and is often
widened with rib spreaders. Patient has to be placed in a lateral decubitus position for
this approach. All pressure points should be padded. A pillow should be placed between
the two legs. Both arms should be flexed and maintained in “prayer position”. A roll can
be placed under the 5th intercostal space
It is a very common approach for operations on the lung or posterior mediastinum,
including the esophagus.

Anterolateral thoracotomy is performed upon the anterior chest wall. The skin incision is
performed starting from the posterior axillary line in front of the tip of the scapula towards
the submammary crease. The anterior intercostal spaces are wider as compared to the
posterior spaces hence provide better exposure while minimising the need for excess rib
spreading. It gives a very adequate exposure of lungs, pericardium and diaphragm.

Complications[edit]
In addition to pneumothorax, complications from thoracotomy include air leaks, infection,
bleeding and respiratory failure.[9] Postoperative pain is universal and intense, generally
requiring the use of opioid analgesics for moderation, as well as interfering with the
recovery of respiratory function. Paraplegia complicating thoracotomy is rare

Pain following a thoracotomy may be treated by the use of a nerve block known as
a rhomboid intercostal block

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