Thoracotomy 1111339 225426405 2008-07-13T17:07:51Z Frank 1475157 Removing backlinks to Air leaks that has been speedily deleted per ([[WP:CSD#A1|CSD A1]]); using [[WP:TW|TW]] '''Thoracotomy''' is an incision into the [[chest]]. It is performed by a surgeon, and, rarely, by emergency physicians and [[paramedics]], to gain access to the thoracic organs, most commonly the [[heart]], the [[lung]]s, the [[esophagus]] or thoracic [[aorta]], or for access to the anterior [[vertebral column|spine]] such as is necessary for access to tumors in the spine. Thoracotomy is a major surgical maneuver—the first step in [[cardiothoracic surgery]], which involves major procedures such as [[coronary artery bypass surgery]] and [[lobectomy]] or [[pneumonectomy]] for [[lung cancer]]—and as such requires [[general anesthesia]] with [[endotracheal tube]] insertion and [[mechanical ventilation]]. ==Approaches== There probably are many different approaches to thoracotomy. The most common modalities of thoracotomy follow. '''Median sternotomy''' provides wide access to the mediastinum and is the incision of choice for most open-heart surgery and access to the [[anterior mediastinum]]. '''Posterolateral thoracotomy''' is a very common approach for operations on the [[lung]] or [[posterior mediastinum]], including the [[esophagus]]. When performed over the 5th intercostal space, it allows optimal access to the pulmonary [[hilum]] ([[pulmonary artery]] and [[pulmonary vein]]) and therefore is considered the approach of choice for pulmonary resection ([[pneumonectomy]] and [[lobectomy]]). '''Anterolateral thoracotomy''' is performed upon the anterior chest wall; left anterolateral thoracotomy is the incision of choice for open chest massage, a critical maneuver in the management of traumatic [[cardiac arrest]]. Anterolateral thoracotomy, like most surgical incisions, requires the use of tissue [[retractor (medical)|retractors]]—in this case, a "rib spreader" such as the Tuffier retractor. Bilateral anterolateral thoracotomy combined with transverse sternotomy results in the '''"clamshell" incision''', the largest incision commonly used in [[thoracic surgery]]. Upon completion of the surgical procedure, the [[chest]] is closed. One or more [[chest tube]]s—with one end inside the opened [[pleural cavity]] and the other submerged under saline solution inside a sealed container, forming an airtight drainage system—are necessary to remove air and fluid from the [[pleural cavity]], preventing the development of [[pneumothorax]] or [[hemothorax]]. ==Complications== In addition to [[pneumothorax]], complications from thoracotomy include air leaks, [[infection]], [[bleeding]] and [[respiratory failure]]. Postoperative [[pain]] is universal and intense, generally requiring [[opioids]], and does interfere with the recovery of respiratory function. In the long term post operatively chronic pain can develop known as thoracotomy pain syndrome, this can last from a few years to a lifetime of continued pain and discomfort. One has to realise that this procedure is a major insult to the human body and one which is only ever performed for most serious conditions. Treatment to aid pain relief for this condition includes intra thoraic nerve blocks/opiates although results vary from person to person and are dependent on many numerous factors. ==VATS== '''Video-assisted thoracic surgery''' (VATS) is a less invasive alternative to thoracotomy in selected cases, much like [[laparoscopic surgery]]. Like laparoscopic surgery, its applications are rapidly expanding. [[Robotic surgery]] is a new but rarely used innovation with questionable advantages. {{Respiratory system surgeries and other procedures}} [[Category:Surgical procedures]] [[Category:Surgery]] [[Category:Thoracic surgery]] [[de:Thorakotomie]] [[fr:Thoracotomie]] [[no:Thoracotomi]]