Under thoracotomy is meant the surgical opening of the thorax by a taking place between two ribs intercostal section (of Ferdinand Sauerbruch in Zurich - 1910-1914 - so named intercostal incision in the intercostal space ). A distinction is made between different variants of the thoracotomy, depending on the location of the incision and the size of the intervention.
The most common variant of the thoracotomy is the posterolateral (lateral) incision in the 5th intercostal space running roughly from the lateral edge of the shoulder blade to the mammillary line . The thorax is opened over a length of approximately 25 cm. This access is used for the surgical removal of parts of the lung, lobes or an entire lung, for example in tumors of the lungs.
In the case of a transplantation of both lungs, instead of the lateral access, an incision is made on the anterior trunk wall in the 4th intercostal space, along the entire length between the two axillary lines . This much more complex operation is necessary as a result of pulmonary fibrosis, for example . Due to the incision over both halves of the thorax, significantly more skin and muscle tissue is severed, which makes postoperative healing more complex.
The dorsal thoracotomy is one of the oldest approaches. Today, however, it is only chosen in special cases, for example in the case of difficult-to-reach, dorsal-wall tumors. The cut runs below the shoulder blade . Since several strong muscles of the rear trunk muscles (including the trapezius muscle ) have to be severed with this incision , this path is considered to be significantly more traumatic and more painful to heal than the posterolateral incision.
In some, predominantly Anglo-Saxon countries, a so-called clamshell thoracotomy (bilateral anterior thoracothomy) is performed in emergency medicine , which means the complete opening of the thorax in the 5th intercostal space (space between the ribs). The objective of this procedure is the pericardium to open, proximal Aortenkompression and an internal cardiac massage to be performed. An indication of a clamshell thoracotomy is a cardiac arrest in the case of a penetrating thoracic or upper abdominal injury if this does not allow external chest compressions.
It is contraindicated in blunt abdominal trauma , in patients who have not had cardiac output for more than 10 minutes, and in every patient who still has a measurable pulse. The procedure is also not recommended for patients with massive skull injuries or for unskilled personnel or insufficient equipment. The procedure should generally only be carried out if the patient cannot be treated surgically within 10 minutes of the onset of cardiovascular arrest.
This means a thoracotomy with an incision no longer than 10 cm. This type of surgical approach is usually used for diagnostic lung wedge resections when specimens cannot be obtained using video-assisted thoracoscopy (VATS). A mini-thoracotomy is also usually used when a thoracic drain is installed, in contrast to the previous use of a trocar .
Definition of terms
It is also possible to open the thorax by means of a longitudinal incision through the sternum . Due to the fundamentally different approach (not parallel to the ribs), this sternotomy is seen as a separate approach and is not counted among the thoracotomies, although it also opens the thorax.
- ^ Ferdinand Sauerbruch , Hans Rudolf Berndorff : That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951; cited: Licensed edition for Bertelsmann Lesering, Gütersloh 1956, pp. 138 f and 145 f.
- ↑ Henne-Bruns, Dürig, Kremer: Chirurgie, 2nd edition, Thieme, Stuttgart 2003, p. 816 ff.
- ^ Tuberculosis: Samba in four days. Der Spiegel, No. 16/1950  .
- ↑ Emergency Medicine Journal: Emergency thoracotomy: “how to do it” Emerg Med J 2005; 22: 22-24 doi : 10.1136 / emj.2003.012963 .