Thoracotomy

Thoracotomy is a surgicalincision into the chest. It is performed by a surgeon to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagusor thoracic aorta, or for access to the anterior spine.

Thoracotomy is a major surgical maneuver -- the first step in thoracic surgery, which involves major procedures such as coronary artery bypass surgeryand pneumonectomyfor lung cancer-- and as such requires general anesthesiawith endotracheal tubeinsertion and mechanical ventilation.

There are many different approaches to thoracotomy. The most common modalities of thoracotomy follow.

Median thoracotomy provides wide access to the mediastinum and is the incision of choice for most open-heart surgery.

Posterolateral thoracotomy is a very common approach for operations on the lungsor mediastinum, including the esophagus. When performed over the 5th intercostal space, it allows optimal access to the pulmonary hilum(pulmonary arteryand pulmonary vein) and therefore is considered the approach of choice for pulmonary resection (pneumonectomyand pulmonary 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 retractors-- in this case, a "rib spreader" such as the Finochietto retractor.

Bilateral anterolateral thoracotomy combined with tranverse sternotomy results in the "clamshell" incision, the largest incision commonly used in thoracic surgery.

Upon completion of the surgical procedure, the chestis closed. A chest tube -- with one end inside the violated pleural cavityand the other submerged under saline solution inside a sealed container, forming an airtight drainage system -- is necessary to remove air from the pleural cavity, preventing the development of pneumothorax.

In addition to pneumothorax, complications from thoracotomy include infection, bleedingand respiratory failure. Postoperative painis common and intense, generally requiring opioids, and interfering with the recovery of respiratory function.

Video-assisted thoracic surgery (VATS) is currently being explored as an alternative to thoracotomy in selected cases, much like laparoscopic surgery. Unlike laparoscopic surgery, its current indications are relatively limited. Robotic surgeryalso holds promise.no:Thoracotomi

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It uses material from the http://en.wikipedia.org/wiki/Thoracotomy Wikipedia article Thoracotomy.