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What Are the Main Types of Thoracic Incisions?

When are thoracic incisions performed?

Through a thoracic incision, the surgeon can access  the lungs, heart, food pipe (esophagus), thoracic aorta, or the spine. Through a thoracic incision, the surgeon can access the lungs, heart, food pipe (esophagus), thoracic aorta, or the spine.

A thoracic incision is a surgical cut made on the chest (thorax) to get access to the space between the lungs and chest wall.

Through a thoracic incision, the surgeon can get access to the organs in the chest (thoracic organs) such as the lungs, heart, or food pipe (esophagus), the thoracic aorta (part of the aorta, the major blood vessel, in the chest) or the spine. The appropriate thoracic incision is the one that will provide the best exposure to the region of the chest being addressed in a given procedure.

Thoracic incisions are performed in patients undergoing surgeries for the following conditions:

  • Lung cancer
  • Noncancerous lung masses
  • Disorders of the heart
  • Aortic aneurysm (ballooning or bulging of the aorta at certain weak areas in its wall)
  • Aortic dissection/transection (tears in or rupture of the aorta)
  • Tumors in the spine
  • Tumors in the esophagus
  • Chest injuries

What are the main types of thoracic incisions?

There are various types of thoracic incisions depending upon the organ or structure in the chest that has to be operated upon. The surgeon decides which incision to make for the organ. An important guiding principle in giving a thoracic incision is the preservation of the chest wall function and appearance to the extent possible.

The various types of thoracic incisions are as follows:

  • Sternotomy: It is made over the breastbone (sternum). Different types of sternotomy incisions are:
    • Median sternotomy: This incision is made in the midline along the length of the sternum. It is the incision of choice for most surgical procedures on the heart. It gives excellent exposure of the heart, covering of the heart (pericardium), great vessels, thymus, and lower part of the windpipe (trachea). This incision is quick to perform and less painful compared with a thoracotomy incision.
    • Reoperative or repeat sternotomy
    • Partial sternotomy
  • Thoracotomy: It is the most widely used for thoracic procedures. It is of four major types:
    • In posterolateral thoracotomies, the incision runs toward the back and side of the chest.
    • In anterolateral (anterior) thoracotomies, the incision runs toward the front and/or side of the chest.
    • In axillary thoracotomies, the incision is made on the armpit (axilla).
    • In muscle-sparing thoracotomies, incisions are spared or avoided on a muscle or muscle group in the chest. Its advantages are reduced postoperative pain, decreased narcotic usage and improved shoulder-girdle muscle strength. 
  • Anterior mediastinoscopy: This incision is done to stage and diagnose advanced upper-lobe lung cancers
  • Transverse thoracosternotomy: It involves a long horizontal incision made on the chest. This incision provides excellent wide exposure to both the lungs and great vessels, but it causes increased postoperative pain, frequently requires the patient to be on postoperative ventilatory support and carries a serious risk of breastbone malunion (improper joining of the surgically cut breastbone) and chest wall dysfunction.
  • Thoracoabdominal incision: It provides wide exposure of the lower chest and upper abdomen and is suitable for surgeries on the esophagus, abdominal part of the aorta and spine.
  • Video-assisted thoracoscopic surgery (VATS): It is a procedure in which thoracoscope (a small tube) is inserted through a small incision between the ribs. A small camera is attached at the end of the tube which lets the surgeon observe the entire chest cavity without having to open the chest or spread the ribs.

What are the risks of thoracic incisions?

The complications of thoracic incisions vary with the type of incision made. Generally, the complications include

  • Pain
  • Scarring
  • Nonunion or malunion of the sternum
  • Bleeding
  • Infections
  • Injury to muscles, nerves or blood vessels

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