thoracotomy
Meaning of thoracotomy: Ribs are spread apart to reach the lung, heart or esophagus, which is why recovery takes far longer than keyhole surgery.
Definition of thoracotomy
A thoracotomy is an operation that opens the chest wall through an incision between the ribs, giving the surgeon direct access to the lungs, heart, esophagus or major blood vessels. It is performed to treat disease and sometimes to take a tissue sample, in situations where smaller approaches cannot reach the structure involved or cannot answer the question being asked.
How thoracotomy is built
- thorac/o Combining form · Greek chest, thorax
- -otomy, -tomy Suffix · Greek cutting into, incision
A medical term is read from its ending backwards: the suffix first, then the prefix, then the root. See all 223 word parts.
Where is the cut made?
The incision runs between two ribs rather than through them, and its position depends on what has to be reached. The commonest route curves from below the shoulder blade around the side of the chest, dividing the broad muscle of the back on the way. A cut toward the front spares more muscle and suits some lung and heart work. A short opening in the armpit is used where the target is limited. Once the layers of the chest wall are open, a retractor spreads the ribs apart to create a working gap, and occasionally a short length of rib is removed to widen it. An opening made lengthwise through the breastbone is a different operation, a sternotomy, and is not a thoracotomy.
How does it compare with keyhole chest surgery?
| Feature | Thoracotomy | Keyhole approach |
|---|---|---|
| Access | One long opening, ribs spread | Several small ports and a camera |
| View of the field | Direct sight and touch | Magnified image on a screen |
| Pain afterward | Considerable, and slower to settle | Usually less |
| Where it is chosen | Bulky or awkwardly placed disease, dense scarring, bleeding | Most routine sampling and lung removal |
Where either route could achieve the same result, the smaller one is generally preferred, and a keyhole operation can be converted to an open one partway through if the view proves inadequate or bleeding occurs. Thoracotomy is kept for situations offering a clearer or safer path to the structures involved, which is a judgment about the particular problem rather than a ranking of the two techniques.
Why is recovery harder than after a smaller operation?
Spreading the ribs stretches the joints where they meet the spine and bruises the nerves running along the lower edge of each rib. The resulting pain is felt with every breath, so deep breathing and coughing become difficult at exactly the point they matter most for clearing the lungs. Pain control, breathing exercises and early movement are therefore standard parts of care afterward, and one or more drains sit in the chest for a period to remove air and fluid. A minority of people develop lasting nerve pain along the scar, which is recognized as a specific complication of this invasive procedure rather than a sign that something went wrong.
Used in a sentence
A thoracotomy was performed to remove the lung mass identified on imaging.
Good to know
Thoracotomy and minimally invasive chest procedures can access similar structures, but thoracotomy typically involves a longer recovery due to the larger incision through the chest wall muscles.
Word origin
Where “thoracotomy” comes from
Formed from Greek thorax, thorak-, meaning chest, and -otomy, from Greek tome, meaning a cutting.