Mesothelioma Treatments: Surgical Techniques -
Thoracotomy
A thoracotomy is a surgical technique where a large
incision is made in the sides of the upper torso or chest so a surgeon can
perform open surgery to the patient’s thorax. A number of approaches can be used
during a thoracotomy, but surgery for mesothelioma generally requires a
posterolateral thoracotomy, which is a side thoracotomy that maximizes
exposure to the lungs, the pleura and the surrounding tissue areas. It is major
operation, requiring proper patient care and preparation, as well as significant
post-operative healing.
Thoracotomy – Overview of the Procedure
The patient will be given general anesthesia before the incision and will
be closely monitored during the thoracotomy and subsequent surgery. When the
operation is ready to begin, the patient is placed on his or her side, with
one shoulder and side facing up and the other tucked under the body. The
side that is facing up is the side through which the surgeon will enter the
body. The patient is secured in this position so he or she can’t be moved
during the surgery. The patient’s legs and knees are positioned in a way to
maximize blood flow and to prevent the development of any complications
during surgery.
The surgeon is likely to mark the incision path on the
exposed skin using a marker or felt-tipped pen. This path
will follow the course of the underlying ribs. When the
surgeon begins the incision, he or she will make multiple
passes along this path, with each pass cutting through
another layer of tissue, each one deeper that the next.
The surgeon will soon be faced with how to proceed
through the latissimus dorsi, which is the large
muscle that proceeds along the lateral side of the body and
is involved in most movements of the body’s trunk.
Traditional posterolateral thoracotomy cut through
this muscle, which can significantly increase recovery time,
while modern methods can sometimes fully or partially
preserve the muscle, but at the expense of less thoracic
exposure and longer time in surgery. The decision on how to
perform this part of a thoracotomy will be determined by the
surgeon.
Upon reaching the rib cage, the surgeon will use a rib
spreader, which is a device that will expand the space
between two ribs, to gain access to the organs and tissues
contained therein. Once the spreader has been secured, he or
she can then begin whatever procedure the thoracotomy was
conducted for.
Upon completion of the intended procedure, the surgeon
must backtrack his or her way out of the patient’s chest,
one step at a time, being just as careful with his or her
technique as during this exit as during the initial entry.
After the procedure has been completed, the patient will be
moved into the Intensive Care Unit for post-operative
monitoring and then from ICU if he or she does not show any
signs of post-operative complications.
There is often an extended recovery period for procedures
involving thoracotomy.
Thoracotomy – Treatment Considerations and Conclusions
As can be seen from the above description, a thoracotomy is a highly
invasive operative technique, with a significant chance of perioperative
("during surgery") or postoperative complications—especially for
patients whose latissimus dorsi is fully transected. There is an
extensive recovery time related to the procedure and the pain associated
with it must be treated with strong pain medication. Because of these
issues, use of thoracotomy has been superseded by VATS for most diagnostic
or palliative purposes, due to VATS’ successes as a complimentary and less
invasive procedure. However, for patients who require extensive thoracic
surgery, such as pleurectomy-decortication or
extrapleural pneumonectomy, thoracotomy is still the
best available method to maximize exposure to the pleural cavity.
Related Information: Mesothelioma &
Surgery
For more information related to the surgical treatment of mesothelioma, please read the following:
|