Thoracotomy is the critical surgical strategy in which a surgeon examines the chest cavity. It is a method in which the surgeon makes an opening in the chest, gains entry into the pleura’s space, and obtains information about the thoracic cavity, which is the 2nd topmost hollow space in the human body. In this procedure, a cut or rib section is removed to gain chest cavity access. Thoracotomy is done in the operating theater under GA. It is done to deal with lung cancer in which the neoplastic part can be extracted and treat and diagnose other problems related to the thoracic cavity. The surgeon can remove a piece of tissue to get more information (biopsy).
Organs of the chest cavity
The organs of the thoracic cavity are referred to as thoracic organ, and they include;
- Lungs
- Heart
- Diaphragm
- Esophagus
Thoracotomy also allow access to;
- The largest artery of the body, i.e., the aorta
Uses of thoracotomy
It is an effective procedure in which the surgeon exposes the chest cavity and zone between the two mediastinum lungs to examine the lungs, heart, aorta, food pipe, and the spine’s anterior part.
- Indications:
- Neoplastic food pipe surgery
- Cancerous Lung surgery
- Cardiac surgery
- Trauma of chest
- Collapsed lungs, which is also called persistent pneumothorax
- COPD management
- Tuberculosis
- Biopsy and examination of the mediastinum
- Front of spine surgery
- Resuscitative thoracotomy; is done in an emergency of a chest injury. It is a procedure in which the surgeon opens up the chest to control bleeding from thorax blood vessels, to maintain systemic circulation, and it also helps to remove the compressive force of the heart.
Procedures
There are several types of procedures which are selected, according to the condition of the patient. It includes;
Lateral posterior thoracotomy:
The standard method in which a surgeon removes the lungs or part of a lung to deal with lung cancer. A cut is made between the ribs at the chest’s side in the posterior direction. In this, the ribs are distanced apart or can also be taken out to examine the lungs, and after this, the surgeon may also remove a lobe of a lung, a whole lung, or a small part of a lung.
Median thoracotomy:
In this procedure, an incision is made in the breastbone that allows access to the thorax. It is generally done for heart surgery.
Axillary thoracotomy:
In this method, the thoracic surgeon made an opening close to the armpit. It is performed for the treatment of collapsed lungs. Heart and lung surgeries can also be done by this method.
Lateral anterior thoracotomy:
It is performed in an emergency in which the surgeon cuts the chest anteriorly. When an individual had chest traumas, anterolateral thoracotomy can be done. After cardiac arrest, it may also help to examine the cardiac parts.
Surgeons of thoracotomy
The following specialist can perform thoracotomy:
Thoracic surgeons specialize in the surgical management of chest cavity disease and the blood vessel, lungs, heart, and food pipe disorder. They are referred to as cardiothoracic surgeons. Cardiac surgeons do specialization in the management of the condition that is related to heart and cardiac vessels. They are also called cardiothoracic surgeons. When an individual had a chest injury or any trauma in which emergency assistance is needed Trauma doctor or medical emergency doctor plays a role in managing such patients.
How to perform thoracotomy?
It is a surgical method in which an incision of 8-10 inches is made in the chest. An Incision made through open surgery allows surgeons to access the area directly. It requires a larger cut, which involves muscle and another tissue displacement. In some cases, surgeons use the modern technique in which a small incision of about 4-6 inches is made. As there is no cutting of muscle, this method is called a muscle-sparing thoracotomy. Instead of cutting, the surgeon isolates the muscle fibers. In this method, patients feel less pain, and recovery time is faster. Other procedure includes VATS, i.e., minimally invasive thoracic surgery which is called as video-assisted thoracoscopic surgery.
Types of Anesthesia
Surgeons use general anesthesia during thoracotomy. GA is the mixture of gases and intravenous medication that makes an individual unaware of the operation, so he does not feel any pain during the procedure. Despite using GA, peripheral nerve block infusion may also be used, blocking the pain signal’s perception. It is a needle that is injected at the site where surgery is to be performed.
Preparation of surgery
Switch drugs for some time before the surgery, a week before you go in for the surgery. The Patient should stop using aspirin, naproxen, or other pain killers. If a patient is taking medication for cardio therapy, do consult the doctor. If a patient is a smoker, he has to stop smoking four weeks before surgery. To build strength, go for a walk daily. Up to 3-4 miles is enough for the Patient. The Patient should use an incentive spirometer to exercise the lungs about three times a day. Quit eating or drinking after midnight, the night before the surgery.
Drawbacks of thoracotomy
When thoracotomy is performed, some individuals encounter complications while others may not experience any drawback. Healthier and immunocompetent individuals have a simple and more effortless operation than those already going through other medical problems. Complications of the surgery may include;
- Ventilatory assistance is needed after surgery.
- There is a chance of persistent leakage of air, requiring a chest tube after the surgery.
- Infection may als0 develop.
- Chances of bleeding are higher.
- After the general anesthesia problem, face the patient.
- The chances of heart attack or abnormal heart rate are 10-15%.
- Dysfunction of the vocal cord.
- Chances of bronchopleural fistula are also present during this surgery. It is a condition in which an abnormal trunk produces between a tube of bronchioles and space between the pleural lining.
- After surgery, individuals may also experience postpneumonectomy syndrome, i.e., the pain in the area where the surgery is performed. The pain may persist for a more extended period.
Recovery after the surgery
When surgery is done, the patient’s body is taken to the recovery room, where nurses monitor the bp, pulse rate, breathing rate, rhythms, and oxygen level. After surgery patient spends his first day in an intensive care unit; once he gets back to his normal condition, he will go to an ordinary room to recover further. After the surgery, the patient stays in the hospital for 4 to 7 days. At first patient experiences breathing difficulty. The patient has to avoid intense activities after the surgery for 6 to 8 weeks.
Things to try After Hospital Release
After you allow the hospital, it will take 4 to six weeks for you to feel up to your regular routine. Twiddling my thumbs.
Your doctor will offer you pain medicine — always take it with food. As you heal, you ought to gradually need less of it.
To speed your recovery and be easier, you might:
• Take warm showers to assist ease pain once your doctor says it’s OK. A hot pad also can help, but don’t put it directly on your skin.
• Sleep during a recliner or on the sofa. once you first get home, soreness may make it hard for you to nod off in your bed.
• Eat a well-balanced diet with many proteins.
• Ease back to physical activity by going for walks but pace yourself as your strength comes back.
• Drink many liquids, and eat tons of fiber — your pain medicine might make it hard for you to possess bowel movements. you furthermore may can try an over-the-counter laxative.
• Wash the world round the cuts gently with soap and water a day , but don’t bathe within the tub.
Symptoms
• You have a temperature above 101 degrees.
• Pus comes out of the cut.
• Your stitches or staples pull loose.
• You vomit tons.
Side effects and complications
Any surgery can have risks. Possible risks from thoracotomy include:
• infection
• bleeding
• air leaking from your lungs
• pneumonia
• blood clot in your leg which will visit a lung and cause a blockage (pulmonary embolism)
Difference between Thoracotomy and VATS
For some people, a less invasive procedure referred to as video-assisted thoracoscopic surgery (VATS) could also be used rather than a thoracotomy, but this is often not available in minor hospitals. During this process, several small incisions are made within the chest. Surgery is performed by inserted a scope with a camera. VATS could also be used even for a few larger procedures like a lobectomy but can’t be performed locations altogether.
The recovery is typically more rapid with a VATS procedure, as long because a surgeon completes it 2016 study found that folks experienced less postoperative pain with a VATS procedure than an anterolateral thoracotomy.3 Since outcomes of carcinoma surgery are better at cancer centers that perform an outsized volume of those surgeries, a second opinion at a National Cancer Institute-designated cancer center could also be a simple idea before scheduling your surgery.
Conclusion
Thoracotomy is a method in which the surgeon made an incision in the thorax to view the chest cavity’s internal organ. After thoracotomy, make a habit of walking three to four times each day. Engage in activities that involve the incision side about 2-3 times daily. Do ROM of the arms ten times. Try not to drive for almost four weeks and do not do lifting approx for 4 weeks.
Also Read: Swai Fish – Everything You want to Know: Major 4 Risks, Amazing Benefits and More