Teknik Operasi

Thoracotomy
Oleh :
Erik Witular K.
DEFINITION
The process of making of an incision(cut) into the chest wall

Indication
Wide variety of elective as well as emergency procedures
left side : the left lung, the heart, descending aorta, lower
esophagus, vagus nerves, and diaphragmatic hiatus
right chest : vena cavas, the right lung, the superior
exposure of the hepatic veins, and the upper esophagus
 Anatomy
Thorax Anterior Thorax Posterior
 Anterior view

MUSCLES OF THORAX
2. M. sternalis
3. M. pectoralis mayor
7. M. pectoralis minor
8. M. subclavia
11. M. serratus anterior
15. External intercostal muscles
16. External intercostal membrane
POSTERIOR THORACIC
Anterior view
WALL
15. External intercostal muscles
17. Internal intercostal muscles
18. Internal intercostal membrane
20. Subcostal muscles
INTERCOSTAL MUSCLES
15. External intercostal muscles
17. Internal intercostal muscles
19. Innermost intercostal muscles
Operation Procedure
Patient lies on his or her side with one arm raised
 Identification tip of scapula
An incision is cut into the skin of the ribcage below the
tip of scapula
Muscle layers are cut
Identificated and retracted the scapula to identificate
the 5th intercostal space
Intercostal muscle are cut above the 5th or 6th costae
Retractors hold the ribs apart, exposing the lung
After any repairs are made, the cut rib is replaced and
held in place with aproximator
Layers of muscle and skin are stitched.
Aftercare
The pressure differences that are set up in the thoracic cavity by the
movement of the diaphragm make the lungs to expand and contract.
If the pressure in the chest cavity changes abruptly, the lungs can
collapse.
Any fluid that collects in the cavity puts a patient at risk for infection and
reduced lung function, or even collapse .
Any entry to the chest usually requires a chest tube remain in place for
several days after the incision is closed.
The first two days after surgery may be spent in the ICU.
A variety of tubes, catheters, and monitors may be required after surgery
Risk
General anesthesia carries such risks as nausea,
vomiting, headache, blood pressure issues, or allergic
reaction.
After a thoracotomy, there may be drainage from the
incision. There is also the risk of infection; the patient
must learn how to keep the incision clean and dry as it
heals
Complication
One study following lung cancer patients undergoing thoracotomy found
that :
1015% of patients experienced heartbeat irregularities, partial or full
lung collapse;
510% experienced pneumonia or extended use of the ventilator
(greater than 48 hours);
up to 5% experienced wound infection, accumulation of pus in the chest
cavity, or blood clots in the lung.
The mortality rate in the study was 5.8%, with patients dying as a result of
the cancer itself or of postoperative complications
THANK YOU...