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A thoracotomy is an open chest surgery procedure. Lateral thoracotomy, also referred to as intercostal thoracotomy, is an open chest surgery procedure performed through an opening in an intercostal space, between the ribs and to the side of the median line. Lateral thoracotomy can be posterolateral, that is through an intercostal space on the back of the torso, or anterolateral, in an intercostal space on the front side of the torso. Intercostal areas are the areas containing muscle between the ribs of the chest.
Lateral thoracotomy can be used to access the thoracic cavity to treat various thoracic diseases and disorders in your dog. Because thoracic organs can not be manipulated to a large degree, the approach to open chest surgery is limited by where the thoracic structures that require surgery are located. Lateral thoracotomy is limited to those thoracic structures that can be accessed by a lateral approach. Lateral thoracotomy may be used as an exploratory method to determine where dysfunction in the thoracic cavity is occurring, or to access adjacent pulmonary or thoracic organs and structures for surgical repair or intervention. When required, an experienced veterinarian can perform a lateral thoracotomy under general anesthetic in your dog.
Lateral thoracotomy will require the administration of general anesthetic and intravenous support for your dog during the procedure. Dogs should be fasted prior to the procedure and administration of general anesthetic. After general anesthetic is established, hair is clipped where the incision on the thorax is to be made, either laterally toward the back between the intercostal spaces for posterolateral thoracotomy or laterally to the side for anterolateral thoracotomy. The area will be thoroughly cleaned and an incision made in the intercostal space to access the thoracic cavity. Thoracic tissues can only be manipulated to a limited degree. Rib spreaders may be used to make space for surgical procedures between the intercostal spaces. Special retractors and clamps will be used in the thoracic cavity to minimize damage and crushing when manipulating thoracic structures, that have a broad clamping surfaces to minimize interference and prevent damage to nerves and blood vessels and other pulmonary and thoracic structures.
Intercostal approach can be made through the 3rd to 10th intercostal spaces to gives access to a specific region of the hemithorax, hilar area of the lungs, heart, mediastinum and ipsilateral thoracic cavity. Radiographs will be conducted prior to surgery to direct which intercostal space should be incised to provide access to the thoracic cavity specific to the disorder being treated. An incision is made in the skin parallel to the ribs and may extend from ventral to the costovertebral junction dorsal to the sternum. Muscles are incised with scissors parallel to this incision and midway between ribs to avoid nerves. The 4th through 6th intercostal spaces are the most often used for access to the thoracic cavity. If a lobectomy is being performed the approach will be centered over the hilus of the lung, not the lesion. The 4th intercostal is used to approach the heart, the 8th for caudal esophagus access. Required repair of thoracic cavity is performed. Drainage tubes will be placed to drain fluid prior to closure of lateral thoracotomy the thoracic cavity is fastened with sutures if required. As breathing will be painful after this procedure, painkiller is administered by local blocks in the intercostal nerves and sub pleurally in the intercostal spaces near the incision. Bleeding will be addressed and litigated as required and incisions closed with sutures.
Your dog’s vital signs will be carefully monitored during the procedure and during recovery and supportive treatment provided.
Lateral thoracotomy has a good success rate for treatment of thoracic disorder that can be accessed by this approach. Complications are minimal and prognosis from the procedure is good, although ultimate prognosis depends on the disease being treated.
Your dog should be put on cage rest following the procedure and activity restricted for several weeks following surgery. Painkiller may be used under the direction of your veterinarian. Your dog will have some pain associated with breathing post-surgery and ensuring that they do not exert themselves will reduce their discomfort. Dogs can be taken on a leash to go to the bathroom outside, but not allowed to run free. Prevent your dog from playing, climbing stairs, jumping on furniture or using slippery floors during the immediate recovery period. Staples or sutures are removed in 10 to 14 days. Ensure your dog doesn't lick or chew its incision; an e-collar may be used to prevent this. Your dog should be monitored for signs of illness or infection and veterinary care obtained as required.
Lateral thoracotomy requires specialized surgical instruments, experience, and training by your veterinary surgeon, contributing to the cost of the procedure. The cost can range from $2,000 to $5,000 including anesthesia and hospitalization.
Dogs requiring thoracotomy may be experiencing severe illness and risk from general anesthesia and surgery may be considerable in their condition. Prognosis for cancerous lesions in pulmonary tissue or cardiac and pulmonary diseases are often poor and this should be considered prior to surgical intervention.
Preventing injury that may result in disorder in the thoracic cavity will reduce the likelihood of thoracotomy being required in your dog. Many thoracic and cardiac disorders are not avoidable and are serious in nature. Receiving prompt care for thoracic disorder when it manifests may minimize the invasiveness of intervention required.
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