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What is a thoracotomy?

A thoracotomy is a surgical incision between the ribs to access the inside of your thorax or chest, including organs like the lungs, heart or esophagus. You may have this surgery to help diagnose a condition or as part of your treatment plan. 

The most common reason to have a thoracotomy is for the care of lung cancer. However, several other conditions might need a thoracotomy, too. This procedure is performed by thoracic surgeons, who specialize in treating conditions in the chest using surgery.

Types of thoracotomy surgery

There are different types and approaches to thoracotomy surgery based on the goals of your procedure. For example, the incision on your chest could be made in a few different locations—the right side, the left side, the center at the breastbone or close to the armpit.

A thoracotomy is used when a minimally invasive alternative, such as video-assisted thoracoscopic surgery, known as VATS, is not feasible. Thoracoscopy uses several smaller incisions and a scope with a camera to view the inside of the chest and perform surgery and allows for a faster recovery time. 

Posterolateral thoracotomy

Posterolateral thoracotomy is the most common type of thoracotomy, and it is used to reach your lungs. An incision between the ribs is made either on the right side or left side of your chest around toward your back. Then, your surgeon may spread apart your two ribs or remove a rib to access the lungs better.

You could have this type of thoracotomy as part of your lung cancer treatment. It’s often an option when your surgeon needs to remove the entire lung that’s affected by cancer, called a pneumonectomy, or to remove a lobe of the lung called a lobectomy.

Thoracotomy vs. thoracotomy

While thoracotomy and thoracostomy are procedures performed in the chest, the extent and goals of these procedures differ. A thoracotomy uses a larger incision to allow your care team to reach the tissues and organs inside the chest to perform surgery.

A thoracostomy is a small incision to insert a tube into the chest. This tube lets your care team drain air, fluid or blood. It’s often used for infections like pneumonia, bleeding in the chest or to relieve fluid buildup from cancer in the chest.

Reasons for a thoracotomy

Thoracotomy procedures are used to diagnose or treat lung cancer not responsive to a minimally invasive approach. Surgeons may use this surgery to take a lung biopsy to diagnose lung cancer or to remove all or part of a lung that’s affected by cancer. But you may need a thoracotomy for a variety of reasons.

In addition to lung cancer, you could have a thoracotomy for:

  • Esophageal cancer
  • Surgery to treat heart conditions
  • Problems with the major artery in your chest called the aorta
  • Other lung conditions, like a collapsed lung or COPD
  • Fluid buildup in the chest, called pleural effusion
  • Removal of a rib
  • Some spine conditions
  • Emergency resuscitation, chest bleeding or major trauma in the chest

How to prepare for a thoracotomy

In some cases, thoracotomy is an emergency or urgent procedure. But most of the time, your care team will help you plan for your procedure. Before your surgery, you may also have additional tests to make sure you are healthy enough for a thoracotomy.

In the weeks leading up to your surgery, you can take steps to help you recover smoothly. For example, talk with your doctor about stopping medications, quitting smoking and adding exercise, such as walking to your daily routine. You should also make plans for support when you return home from the hospital.

The thoracotomy procedure

A thoracotomy procedure is a major surgery that can take several hours. You’ll have general anesthesia to make you sleep during the procedure, and you will need to stay in the hospital to recover. From preparing for surgery to discharge from the hospital, your care team will guide you through each step of the process.

Before a thoracotomy

Before your procedure, your doctor will give you instructions about stopping medications, such as blood thinners or non-steroidal anti-inflammatory drugs. You’ll also be asked to avoid eating or drinking anything after midnight before your thoracotomy.

When you arrive on the day of your surgery, you’ll go to pre-op, where several members of your care team will get you ready for surgery and answer any questions. You’ll have monitors to check your vital signs and an IV placed.





During a thoracotomy

In the operating room, your care team will position you to allow your surgeon to access the area of the chest where a thoracotomy will be performed. Your surgeon will then make an incision in the chest—with the location based on the type of thoracotomy. This incision could be a few inches to several inches long.

Depending on the goals of your surgery, your surgeon will also spread your ribs apart or divide or break a rib to have better access to the inside of the chest. Once your surgeon has completed your specific procedure—such as repairing or removing sections of tissue or organs—the incision is closed, and a chest tube is placed to help drain fluid and air.



After a thoracotomy

When you wake up after your thoracotomy, you’ll have a chest tube and monitors connected to you. You’ll spend some time in the surgery recovery area or possibly the Intensive Care Unit before you’re moved to a hospital room. Most people stay in the hospital for up to a week after a thoracotomy.

During your hospital stay, your care team will teach you how to prevent a chest infection—such as deep breathing and coughing—and prevent blood clots—like leg exercises. They’ll also work with you to manage your pain and make you as comfortable as possible.

When it’s time to go home, you’ll get instructions on activities to avoid and how to continue caring for yourself as you recover. It typically takes about six to eight weeks to start feeling like yourself again after a thoracotomy.

Risks and complications

As with any surgical procedure, some risks come with a thoracotomy. The risks of your procedure depend on factors like your health history and the specific type of surgery you have. You may have side effects related to the anesthesia, such as nausea, vomiting, headaches or blood pressure changes. Several other risks are possible, specifically related to a thoracotomy.

Risks or complications of a thoracotomy include:

  • Infections, such as pneumonia
  • Need for extended breathing assistance or a chest tube after surgery
  • Excessive bleeding or hemorrhage
  • Persistent post-surgery pain, called post-thoracotomy pain syndrome
  • Heart problems, including heart attack or arrhythmia
  • Collapsed lung
  • Abnormal connection (fistula) between a bronchial tube and the lining around the lungs
  • Blood clots

Frequently asked questions

  • How long does a thoracotomy take?

    Thoracotomy surgery can take anywhere from three to six hours to complete. The time will vary depending on the specific type of surgery being performed.

  • How long does pain last after thoracotomy?

    You may have pain near your incision and in the chest area for a few weeks after your thoracotomy. While pain usually gets better within days or weeks, there is a risk of ongoing pain that can last months, called post-thoracotomy pain syndrome.

  • How painful is a thoracotomy?

    Discomfort is common after a thoracotomy. This major surgery involves layers of tissue and muscle and spreading or removing a rib. In the first weeks after surgery, pain is often worse when breathing deeply. Your care team will work with you to provide multiple options for pain relief. Typically, a nerve block or ablation is performed during surgery to minimize the severity and duration of this pain.

  • Is thoracotomy a major surgery?

    Yes. Thoracotomy is considered a major surgery. It uses a larger incision and an open surgical approach. Because of this, it’s typically only used to treat serious conditions that don’t have other less invasive options.

  • How long does it take to recover from a thoracotomy?

    The average recovery time from a thoracotomy is about six to eight weeks. During this time, it’s common to have pain, feel tired and need help with certain activities. For a few months, you may also have general stiffness or numbness, tightness or itching in your incision area.