Introduction Thoracic Surgeries And Interventions

Question 1

Overview of thoracotomy surgery

Answer 1

Video assisted thoracotomy
Posterolateral thoracotomy
Median sternotomy
Anterolateral thoracotomy
Lateral
Subxiphoid incision
Thoracoabdominal

Question 2

What is posterolateral thoracotomy used most for?

Answer 2

Pulmonary thoracic procedures

Question 3

When is a median sternotomy used?

Answer 3

Almost exclusively used for cardiac procedures

Question 4

What is the posterolateral thoracotomy approach used for?

Answer 4

Hemo or pneumo thorax
Pulmonary restrictions
Gives good visibility - easiest for access to the lungs
Pain, mobility and pulmonary issues
Muscle sparing - has better functional results

Question 5

Anterolateral thoracotomy - Left incision

Answer 5

Cardiac tamponade
Descending thoracic aorta repair
Pericardial effusion, left pneumonectomy

Question 6

Anterolateral Thoracotomy - Right Incision

Answer 6

Right pneumonectomy
Distal esophageal surgeries
Access to the hilum
Mitral valve repair/replacement (minimal incision)

Question 7

What muscles are impacted by an anterolateral thoracotomy?

Answer 7

Pectoralis muscles
Serratus
All intercostals

Question 8

Axillary (Lateral) Thoracotomy most frequent use

Answer 8

Minimally invasive cardiac procedures and epicardial pacemaker placement
Shorter length incision to be muscle sparring for chest and shoulder muscles - important for return to function

Question 9

Disadvantages of axillary lateral thoracotomy

Answer 9

Least amount of visibility for surgeon

Question 10

Advantages for axillary lateral thorocotomy

Answer 10

Minimizes change in pulmonary function and mobility
Greatly aids recovery

Question 11

Subxiphoid incision

Answer 11

Pericardium or epicardium procedures

Question 12

Thoracoabdominal

Answer 12

Diaphragmatic procedures

Question 13

Minithoracotomy

Answer 13

Refers to shorter incisions used in surgical techniques

Question 14

Advantages of video assist and robotic assist thoracic surgery (VATS and RATS) vs. open thoracotomy

Answer 14

Greater delicate handling and precision of instrument for surgeons
Reduced hospital length of stay
Decreased blood loss
Lower incisional pain
Less negatively affected pulmonary function (lung volumes)
Earlier patient mobility
Decreased inflammatory cytokines reaction to surgery —> less change of heart attack or infectious response

Question 15

Thoracic surgical complications

Answer 15

Most often related to pain, blood loss/bleeding, medication effects and infection

Question 16

Thoracic surgical complications - Major causes of perioperative morbidity and mortality

Answer 16

Respiratory complications
Prolonged air leaks
Cardiac complications

Question 17

Respiratory complications of thoracic surgical complications

Answer 17

Atelectasis - lung collapse
Pneumothorax - air in lungs
Pneumonia - lung infection
Respiratory failure

Question 18

Cardiac complications of thoracic surgery

Answer 18

Arrhythmias
Ischemia

Question 19

Muscles commonly involved with chest surgeries

Answer 19

Third interspace
Latissimus dorsi
Serratus
Pec major
Trapezius
Rhomboids
Teres major

Lymph nodes also involved

Question 20

Nerves commonly involved with chest surgeries

Answer 20

Intercostobrachial nerve
Thoracodorsal nerve
Long thoracic nerve

Question 21

Early therapeutic interventions after a thorocotomy

Answer 21

Splinting for pain
Splinted cough techniques
Incentive spirometer use
Functional mobility to encourage chest expansion and airway clearance
Reducing risk of atelectasis, pneumonia and venous thromboembolism’s by early mobility