It's Topic Tuesday!

Hello everyone, welcome back to another Topic Tuesday! Yesterday, we talked about the median sternotomy, the most common surgical approach used for open heart surgery. Today, we’ll be talking about another approach that surgeons use, known as the posterolateral thoracotomy.

https://geekymedics.com/cardiothoracic-incisions/

A posterolateral thoracotomy is a type of chest incision that allows surgeons to access the structures inside the chest cavity, especially the lungs, esophagus, and most importantly for our purposes, the aorta. The name comes from the location and direction of the cut: “postero-” refers to the back, and “-lateral” means the side. In this approach, the incision usually begins near the shoulder blade and extends downward and slightly forward, following the curve of the ribs.

To reach the aorta, surgeons carefully separate muscles and spread the ribs to create space.  The specific rib space that is entered depends on the surgeon and the part of the aorta that will be operated on. In some cases, a portion of a rib may be removed to allow better access. 

The portions of the aorta that are best visualized with this incision are the descending thoracic aorta along with abdominal aorta. For this reason, patients requiring open surgical repair of the descending thoracic aorta or both the descending thoracic and abdominal aorta (known as the thoracoabdominal aorta) will often receive a posterolateral thoracotomy. This most often includes patients with aortic aneurysms who are better suited to open surgery than endovascular (stent-based) treatment, or those who have failed such treatment. Patients with chronic Type B aortic dissections may also receive open surgery through this incision in certain circumstances, though blood pressure control and endovascular treatments are usually preferred in the management of acute Type B dissection.

https://www.lecturio.com/concepts/thoracic-aortic-aneurysms/

What to Expect Postoperatively:

Because this surgery involves opening the chest and spreading or removing ribs, recovery can take time. Patients can expect a hospital stay of several days to weeks, depending on the complexity of the surgery and baseline health of the patient. Many patients experience pain postoperatively from injury to the nerves that run near the incision. Nerve blocks, epidurals, or medications are often used to help manage this. 

A posterolateral thoracotomy is a major operation, but in experienced hands, it provides safe and effective access to critical parts of the aorta. We hope you learned something new from this week’s Topic Tuesday!