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Thoracotomy is surgical opening of the chest. It is done to evaluate and treat pulmonary problems when noninvasive procedures are nondiagnostic or unlikely to be definitive.

Contraindications: Contraindications are those general to surgery and include coagulopathy that cannot be corrected, acute cardiac ischemia, and instability or insufficiency of major organ systems.

Procedure: Three basic approaches are used.

• Limited anterior or lateral thoracotomy: A 6- to 8-cm intercostal incision is made to approach the anterior structures.
• Posterolateral thoracotomy: The posterolateral approach gives access to pleurae, hilum, mediastinum, and the entire lung.
• Sternal splitting incision (median sternotomy): When access to both lungs is desired, as in lung volume reduction surgery, a sternal splitting incision is used.

Patients undergoing limited thoracotomy require a chest tube for 1 to 2 days and in many cases can leave the hospital in 3 to 4 days. The principal indications for thoracotomy are lobectomy and pneumonectomy (eg, lung cancer surgery). Video-assisted thoracoscopic surgery has replaced thoracotomy for open pleural and lung biopsies.

Complications: Complications are greater than those for any other pulmonary biopsy procedure because of the risks of general anesthesia, surgical trauma, and a longer hospital stay with more postoperative discomfort. Hemorrhage, infection, pneumothorax, bronchopleural fistula, and reactions to anesthetics are the greatest hazards. Mortality for exploratory thoracotomy ranges from 0.5 to 1.8%.

Last full review/revision June 2009 by Noah Lechtzin, MD, MHS

Content last modified June 2009