cardio and thoracic approaches -2

Question 1

lung resection what approach

Answer 1

Posterolateral and lateral thoracotomy

Question 2

cardiac procedures what approach

Answer 2

Median sternotomy

Question 3

pericardium or epicardium what approach

Answer 3

Subxiphoid

Question 4

diaphragmatic​ surgeries and upper abdomen what approach

Answer 4

Lateral or thoracoabdominal

Question 5

bilateral anterolateral thoracotomies other name

Answer 5

Clamshell incision

Question 6

Posterolateral Thoracotomy locations

Answer 6

midway between the spine of the 4th thoracic vertebra and the scapula

curving arch around the tip of the scapula to the 5th or 6th IC space

Question 7

Posterolateral Thoracotomy goes through what muscles

Answer 7

lower trap, serratus anterior and latissimus dorsi is divided

Question 8

what is the risk with Posterolateral Thoracotomy

Answer 8

risk of intercostal nerve damage

Question 9

Lateral Thoracotomy procedure

Answer 9

Lats are retracted & and serratus anterior or intercoastal mm are incised to gain access to 4th, 5th, , or 6th intercoastal space

Question 10

how does Lateral Thoracotomy prevent scapular winging

Answer 10

by preservation of the long thoric nerve

Question 11

pulmonary bleb

Answer 11

a small collection of air between the lung and the outer surface of the lung (visceral pleura)

Question 12

dorsal sympathectomy

Answer 12

cutting and sealing a portion of the sympathetic nerve chain that runs down the back inside the chest, parallel to the spine

Question 13

Axillary Thoracotomyused for

Answer 13

Used for apical bleb resection or dorsal sympathectomy

Question 14

Axillary Thoracotomy incision

Answer 14

Same position as lateral approach, but incision at anterior edge of pec major, extended within 2nd intercoastal space posterior to edge of lats

the lats are spared but the SA and pect major are cut into

Question 15

Median Sternotomy fro what to what

Answer 15

Midline suprasternal notch and extends below xyphoid

Question 16

Median Sternotomy opened with what

Answer 16

Sternal retractor used to open chest

Question 17

Most common Precautions with Median Sternotomy

Answer 17

Avoid heavy lifting, pushing, and pulling maneuvers (>5 lbs) until the thorax has
had time to heal (depends on surgeon but usually 4-6 weeks).
* Additional:

Question 18

Additional Precautions with Median Sternotomy

Answer 18

• Avoid isometric contractions of upper extremities
• Avoid prolonged overhead activity with arms.
• Use of a pillow to brace incision during coughing
• No pulling on bedrails or pushing heavily on armrests with transfers/bed mobility * No wheelchair propulsion
• No formal MMT of the upper extremity

Question 19

Thoracoabdominal Incisions used for

Answer 19

procedures involving the
diaphragm, the upper abdomen, or the retroperitoneal space

Question 20

Thoracoabdominal Incisions often cause problems with

Answer 20

Often cause problems with coughing, deep breathing, and thoracic extension

Question 21

Video-assisted Thoracoscopic Surgery (VATS) procedure

Answer 21

Standard procedure for minimally invasive surgery

performed by making two small holes (ports) with an access incision of only 5 cm in length

Question 22

Video-assisted Thoracoscopic Surgery (VATS) after the procedure

Answer 22

• Patients’ status post thoracotomy experienced more
  postoperative complications in research studies
• Advantages of VATS make it a better option vs thoracotomy when able to be utilized