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: