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What is Thoracotomy Surgery, Procedure and Definition
Thoracotomy is a major operation in which the surgeon opens the chest cavity to remove part or all of a lung. Surgeons most commonly perform thoracotomy to treat lung cancer or severe trauma to the lungs.
Other reasons for thoracotomy include lung abscess that does not respond to antibiotic therapy, chronic obstructive pulmonary disease (copd) in which there is significant alveolar destruction and lung volume resection may be of benefit, severe bronchiectasis with bleeding requiring resection of part of the lung, biopsy of lung tissue or suspected tumor, and lung transplantation. There are three kinds of thoracotomy:
- Wedge resection removes a small segment of lung tissue
- Lobectomy removes an entire lobe of the lung
- Pneumonectomy removes a whole lung
In lung transplantation, the surgeon first performs pneumonectomy and then transplants the donor replacement lung. Thoracotomy entails a hospital stay of up to 10 days, depending on the kind of surgery, and a recuperation period of two to four months though some people can return to most of their normal activities within six to eight weeks. Additional treatment, such as radiation therapy or chemotherapy for lung cancer, may extend the recuperation period.
Thoracotomy – Surgical Procedure
The doctor performs thoracotomy with the person under general anesthesia. The placement and length of the incision depends on the kind of thoracotomy and the reason for performing it. The incision must be between the ribs, and the surgeon must either spread the ribs (using an instrument called a rib spreader) or remove a portion of rib to gain access to the thoracic cavity. The surgeon removes the intended segment, lobe, or entire lung, and places tubes that will drain air, blood, and other fluids during healing.
The operation may take two to six hours, longer for lung transplantation. The person then remains in the recovery room until the anesthesia wears off, with intensive nursing care to maintain breathing and other vital functions. Less invasive approaches that use fiberoptic scopes and a smaller incision are now an option, particularly for biopsies. Such minimally invasive procedures allow quicker operative times and recuperation.
Risks and Complications of Thoracotomy
Because thoracotomy breaches the thoracic cavity, there are significant risks involved with this operation. The most common are bleeding, infection, and pneumothorax. These risks are potentially lifethreatening though are usually readily treatable and survivable. Complications include respiratory failure and recurrence of the circumstance that made the operation necessary. Removal of a complete lung results in the remaining structures of the thoracic cavity shifting position, which can alter heart function, gastric (stomach) function, and breathing.
Outlook and Lifestyle Modifications
Many people spend the first 48 to 72 hours following surgery in the intensive care unit (ICU). Mechanical ventilation ensures that the remaining lung structure inflates fully to provide adequate oxygenation. As the healing process progresses the affected lung (after lobar resection), or remaining lung when the operation is pneumonectomy, expands to fill the thoracic cavity and pulmonary function improves. Most people can sustain strong pulmonary function with only one lung when the remaining lung is healthy and overall health is good.
Lifestyle modifications and prognosis (outlook) vary with the underlying health condition.
See also SMOKING CESSATION; SURGERY BENEFIT AND RISK ASSESSMENT.
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