What is Thoracotomy

Thoracotomy is surgery to open the chest. This is done to get to organs and tissue inside. This surgery is often done to repair or remove chest tissue that is diseased or damaged.

What happens before the procedure?

Medicines

• Ask your doctor about:
  • Changing or stopping your normal medicines. This is important if you take diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your doctor tells you not to.
• You may be given antibiotic medicine.

Staying hydrated

• Follow instructions from your doctor about drinking fluids. Instructions may include:
  • Up to 2 hours before the procedure – you may drink clear liquids. This includes water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• Follow instructions from your doctor about eating and drinking. Instructions may include:
  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You may have tests, such as:
  • X-rays.
  • MRI.
  • CT scan.
  • Tests of lung mucus (sputum culture).
  • Blood tests.
  • Lung (pulmonary) tests.
  • A test of heart function and rhythm (electrocardiogram, ECG).
  • A test to check blood vessels in your lungs (pulmonary angiogram).
• You may be asked to shower with a germ-killing soap.
• Ask your doctor how your surgical site will be marked or identified.
• Plan to have someone take you home from the hospital.
• Do not use any products that contain nicotine or tobacco. These include cigarettes and e-cigarettes. If you need help quitting, ask your doctor.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be placed in one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• A thin tube (catheter) will be placed into your urethra and bladder. This tube drains your pee (urine).
• A tube will be placed down your throat. This tube helps you breathe.
• A 5–10 inch (13–25 cm) cut (incision) will be made in your chest. How big the cut is and where it is depends on the purpose of the surgery.
• A tool (retractor) will be used to separate muscle and tissue. This helps your surgeon get to chest tissue. Your rib cage may also be separated.
• Chest tissue will be taken out as needed.
• A chest tube will be placed between your ribs. This drains fluid from your lungs.
• Your cut will be closed with stitches (sutures) or staples.
• A bandage (dressing) may be placed on the cut.

The procedure may vary among doctors and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored.
• You will be given pain medicine as needed.
• You will have a chest tube. This may stay in place for 24–48 hours. You will be watched for fluid buildup in your lungs.
• You may still:
  • Have a breathing tube.
  • Have an IV tube.
  • Have a tube draining your pee.
• You may have to wear stockings that reduce swelling and lower the risk of blood clots (compression stockings).
• To help prevent lung infection (pneumonia):
  • You may need to do breathing exercises.
  • You may use a tool that measures how much your lungs fill up when you breathe. This is called an incentive spirometer.

Summary

• Thoracotomy is surgery to open the chest to get to the organs and tissue inside.
• This surgery is often done to repair or remove diseased or damaged chest tissue.
• During the procedure, a 5–10 inch (13–25 cm) cut will be made in your chest.
• You may have a chest tube draining fluid from your lungs. This may stay in place for 24–28 hours.

Thoracotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your doctor may also give you more specific instructions. If you have problems or questions, contact your doctor.

Follow these instructions at home:

Preventing lung infection (pneumonia)

• Take deep breaths or do breathing exercises as told by your doctor.
• Cough often. Coughing is important to clear thick spit (phlegm) and open your lungs. If coughing hurts, hold a pillow against your chest or place both hands flat on top of your cut (splinting) when you cough. This may help with discomfort.
• Use an incentive spirometer as told. This is a tool that measures how well you fill your lungs with each breath.
• Do lung therapy (pulmonary rehabilitation) as told.

Medicines

• Take over-the-counter or prescription medicines only as told by your doctor.
• If you have pain, take pain-relieving medicine before your pain gets very bad. This will help you breathe and cough more comfortably.
• If you were prescribed an antibiotic medicine, take it as told by your doctor. Do not stop taking the antibiotic even if you start to feel better.

Activity

• Ask your doctor what activities are safe for you.
• Do not travel by airplane for 2 weeks after your chest tube is removed, or until your doctor says that this is safe.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your doctor tells you, until he or she says that it is safe.
• Do not drive until your doctor approves.
  • Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

• Follow instructions from your doctor about how to take care of your cut from surgery (incision). Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If you cannot use soap and water, use hand sanitizer.
  • Change your bandage as told by your doctor.
  • Leave stitches (sutures), skin glue, or skin tape (adhesive) strips in place. They may need to stay in place for 2 weeks or longer. If tape strips get loose and curl up, you may trim the loose edges. Do not remove tape strips completely unless your doctor says it is okay.
• Keep your bandage dry.
• Check your cut from surgery every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your doctor approves. You may take showers.
• After your bandage has been removed, use soap and water to gently wash your cut from surgery. Do not use anything else to clean your cut unless your doctor tells you to.

Eating and drinking

• Eat a healthy diet as told by your doctor. A healthy diet includes:
  • Fresh fruits and vegetables.
  • Whole grains.
  • Low-fat (lean) proteins.
• Drink enough fluid to keep your pee (urine) clear or pale yellow.

General instructions

• To prevent or treat trouble pooping (constipation) while you are taking prescription pain medicine, your doctor may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber. These include fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Do not use any products that contain nicotine or tobacco. These include cigarettes and e-cigarettes. If you need help quitting, ask your doctor.
• Avoid secondhand smoke.
• Wear compression stockings as told. These help to prevent blood clots and reduce swelling in your legs.
• If you have a chest tube, care for it as told.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have more redness, swelling, or pain around your cut from surgery.
• You have more fluid or blood coming from your cut from surgery.
• Your cut from surgery feels warm to the touch.
• You have pus or a bad smell coming from your cut from surgery.
• You have a fever or chills.
• Your heartbeat seems uneven.
• You feel sick to your stomach (nauseous).
• You throw up (vomit).
• You have muscle aches.
• You have trouble pooping (having a bowel movement). This may mean that you:
  • Poop fewer times in a week than normal.
  • Have a hard time pooping.
  • Have poop that is dry, hard, or bigger than normal.

Get help right away if:

• You get a rash.
• You feel light-headed.
• You feel like you might pass out (faint).
• You are short of breath.
• You have trouble breathing.
• You are confused.
• You have trouble talking.
• You have problems with your seeing (vision).
• You are not able to move.
• You lose feeling (have numbness) in your:
  • Face.
  • Arms.
  • Legs.
• You pass out.
• You have a sudden, bad headache.
• You feel weak.
• You have chest pain.
• You have pain that:
  • Is very bad.
  • Gets worse, even with medicine.

Summary

• Take deep breaths, do breathing exercises, and cough often. This helps prevent lung infection (pneumonia).
• Do not drive until your doctor approves. Do not travel by airplane for 2 weeks after your chest tube is removed, or until your doctor says that this is safe.
• Check your cut from surgery every day for signs of infection.
• Eat a healthy diet. This includes fresh fruits and vegetables, whole grains, and low-fat (lean) proteins.