Thoracic surgery involves any surgery of the chest (not usually involving “open heart surgery”). There are numerous indications for thoracic surgery aside from the few listed here:
- Pneumothorax (collapsed lung)
- Hemothorax (blood in the chest, usually from injury)
- Empyema (pus in the chest, or abscess of the lung)
- Lung biopsy (for diagnosis of possible lung cancer, chronic scarring of the lung, or other lung abnormality)
- Lung cancer
- Other tumors in the chest
- Congenital abnormalities (birth defects)
A lung biopsy involves taking a sample of lung tissue and examining it under a microscope to look for specific diseases. A lung biopsy may be done for lung fibrosis (chronic scarring of the lungs), for suspected lung cancer, or for other lung abnormalities without a clear diagnosis.
A lung biopsy may be done by a radiologist, putting a needle into the lung tissue, under radiology guidance. This can also be done with a surgery called thoracoscopy (means a scope inside the chest) or VATS (Video-assisted Thoracic Surgery).” This is “minimially invasive” surgery of the chest, similar to laparoscopic surgery of the belly. During thoracoscopy, the doctor will give you medicine to make you sleep; it is done under general anesthesia. Then he or she will make 2 or 3 small cuts between the ribs in your chest. He or she will put long, thin tools in these openings and into the space where the air collected. One of the tools has a camera on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to do the surgery.
Sometimes this cannot be completed using thoracoscopy, and in some cases it will require open chest surgery (this is called thoracotomy) to get a sample of lung tissue.
VATS (video-assisted thoracic surgery) also called Thoracoscopy (meaning a “scope” of the chest)
This is “minimially invasive” surgery of the chest, similar to laparoscopic surgery of the belly. During thoracoscopy, the doctor will give you medicine to make you sleep; it is done under general anesthesia. Then he or she will make 2 or 3 small cuts between the ribs in your chest. He or she will put long, thin tools in these openings and into the space where the air collected. One of the tools has a camera on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to do the surgery. This allows for a quicker recovery.
Thoracotomy is open surgery of the chest. Many procedures still need to be performed with open surgery (as opposed to VATS) such as surgery for lung cancer which involves removal of part or all of one lung. In some cases, a surgeon will start a surgery with a VATS, but may not be able to complete the surgery in that manner (due to risk of injury to other organs or due to bleeding, or poor visualization, etc.), and may need to change to an open thoracotomy.
A thoracotomy is done under general anesthesia and involves a large incision across one side of the chest. The surgeon will need to spread the ribs apart to get into the chest; many times this requires removal of part of one or two ribs to get a large enough space to fit a few hands in; otherwise the ribs will break which can cause more pain.
Risks of Thoracic Surgery Include (but not limited to):
- Bleeding, may require a blood transfusion if severe
- Infection in the chest or wounds
- Injury to the lungs or heart, or other important structures in the chest
- Need for further surgery or other procedures
Recovery after Chest Surgery
After surgery you will have one or more chest tubes in your chest to continue draining the chest cavity. Generally most patients will stay in the hospital for 3-7 days, or more, as you recover. You will need to stay in the hospital while the chest tube is in place. The chest tube will be followed by examination and Chest X-rays.
You will be sore for several weeks. Your doctor will give you pain medication to keep your pain controlled.Your doctor will recommend a treatment to help prevent your small airways from closing off. This treatment, called “incentive spirometry,” involves breathing deeply into a hand-held device a number of times each day. It is also very important that you do not stay in bed. Activity, such as walking, although it can be painful, is very important to keep good lung function and to prevent pneumonia. When you are sent home from the hospital, you should walk around your house several times per day, and increase your activity as you can tolerate.
**You should also ask your doctor when you can fly in an airplane again. You will generally need to wait at least 2 weeks, and up to 12 weeks, before flying in an airplane or traveling to areas of elevation higher than 8000ft, as these altitude and pressure changes can cause the lung to re-collapse if the lung is not yet healed.