Thoracic disease including the heart, the lung, the trachea, the esophagus, the diaphragm, the thymus, and the lymph system sometimes requires surgical treatment. The treatment for thoracic disease requires open chest surgery. Open chest surgery is performed by incising between the ribs or by slitting the sternum. The selection of open chest technique depends on the exposure needed with thoracic disease. Since the chest cavity is sometimes narrow and deep, a large area should be prepared for aseptic surgery in case an extension of the incision required.

Intercostal thoracotomy is performed within the left or right lateral recumbency. The left lateral recumbency at the third, fourth, fifth, or sixth intercostal space will provide adequate exposure for lobectomy. A left third and fourth intercostal space thoracotomy allows exposure of the right ventricular tract, main pulmonary artery, and ductus arteriosus. Removal of the pericardial sac can be done from the fifth or sixth intercostal space. A right intercostal thoracotomy provides exposure of right atrium, right ventricle, cranial and caudal vena cava, right lung lobes, and azygos vein. When performing standard intercostal thoracotomy the incisions are made on the latissimus dorsi muscle and the serratus ventralis muscle. Alternative technique provides retracting these muscle by assistant. The scalenus muscle tendon and internal and external intercostal muscle should be cut. This minimal incision of muscle may provide less pain.

Median sternotomy may perform for exposure to both sides of the thoracic cavity. This approach provides for both or partial lung, the cranial and/or caudal vena cava, main pulmonary artery, and the pericardial sac. The part of sternebrae should be left intact to decrease postoperative pain and prevent delayed healing. Skin incision is made on the midline over the sternum. Splitting the sternebrae on the midline will facilitate closure. Bleeding from the sternebrae bone marrow should be managed.

After open chest surgery a chest tube should placed for drainage and treat with pain medication. Chest tube can be removed with short term in intercostal thoracotomy. However, median sternotomy may be observed significant fluid accumulation.

Open chest surgery requires careful management of bleeding, fluid accumulation, pneumothorax, and checking respiratory rate, heart rate, and blood pressure.