Principles of posterolateral thoracotomy and pneumonectomy

Posterolateral thoracotomy is required to gain access to the thoracic cavity. The patient is placed on the operating table in a lateral decubitus position and a single-lung ventilation technique is employed by using a double-lumen endotracheal tube. The incision is made on the side of the chest towards the back between the ribs. Many thoracic surgical procedures can be performed using this approach including lung resections.Pneumonectomy is a surgical procedure to remove the whole lung and is usually performed by posterolateral thoracotomy. It can also be performed using a video-assisted (VATS) technique. Pneumonectomy is indicated where curative surgical resection is not possible with lesser resection. Prior to pneumonectomy, a thorough preoperative assessment of the patient is performed as per the British Thoracic Society guidelines. This procedure leads to considerable reduction in respiratory reserve and is also associated with significant morbidity and mortality. Common complications include arrhythmias, myocardial infarction, pulmonary embolism, pneumonia, empyema, respiratory failure and bronchopleural fistula. The perioperative mortality rate ranges between 6 and 8%. Very dedicated and careful postoperative management is required in specialized centres to avoid complications.