Thoracotomy; with open intrapleural pneumonolysis
CPT4 code
Name of the Procedure:
Thoracotomy with Open Intrapleural Pneumonolysis
Summary
A thoracotomy with open intrapleural pneumonolysis is a surgical procedure involving an incision into the chest (thoracotomy) to access the pleural space and remove fibrous tissue or adhesions (pneumonolysis). This helps improve lung function by allowing the lung to expand more freely.
Purpose
This procedure is typically performed to treat trapped lung conditions caused by pleural disease, pleurisy, or recurrent pneumothorax. The goal is to improve lung function and relieve symptoms such as breathlessness and chest discomfort.
Indications
- Chronic or recurrent pleural effusion
- Lung entrapment due to pleural thickening or fibrosis
- Recurrent pneumothorax not responsive to other treatments
- Severe pleuritic pain that limits daily activities
- Patients who have not improved with less invasive treatments
Preparation
- Patients may be required to fast from midnight before the surgery.
- Adjustments to regular medications may be needed; specific instructions will be provided by the healthcare team.
- Pre-operative diagnostic tests include chest X-rays, CT scans, blood tests, and pulmonary function tests.
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made on the side of the chest to access the pleural space.
- The surgeon will carefully separate and remove the fibrous tissue or adhesions from the lung surface.
- Pleural space is inspected, and any additional adhesions or fibrous tissue are removed.
- Hemostasis is ensured, and the incision is closed with sutures.
- A chest drain may be inserted to remove air and fluid, promoting lung re-expansion.
Tools used: Surgical instruments (scalpel, forceps, scissors), electrocautery, chest drain kit.
Duration
The procedure typically takes about 2 to 4 hours, depending on the extent of the disease and adhesions.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Thoracic surgeon
- Anesthesiologist
- Surgical nurses
- Respiratory therapists
Risks and Complications
- Bleeding
- Infection
- Prolonged air leak
- Lung or heart injury
- Postoperative pain
- Rarely, respiratory or cardiac complications
Benefits
- Improved lung function
- Relief from symptoms such as breathlessness and chest pain
- Reduced risk of recurrent pneumothorax or pleural effusion
Recovery
- Patients typically stay in the hospital for 5 to 7 days post-surgery.
- Pain management with medications.
- Instructions for breathing exercises to aid lung re-expansion.
- Avoid heavy lifting or strenuous activities for several weeks.
- Follow-up appointments for monitoring recovery and chest drain removal, if inserted.
Alternatives
- Medical management with medications like diuretics or anti-inflammatory drugs.
- Less invasive procedures like thoracentesis or pleurodesis.
- Video-Assisted Thoracoscopic Surgery (VATS) for those who are not candidates for open surgery.
- Each alternative has different benefits and risks which should be discussed with a healthcare provider.
Patient Experience
- During the procedure, the patient will be asleep under general anesthesia.
- Post-surgery, there may be significant pain managed with medications.
- Physical discomfort is expected but lessens over time.
- Stiffness and limited movement initially, improved with physical therapy.
- Gradual return to normal activities as healing progresses.