The procedure varies based on the indication and approach:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Chest X-ray, CT scan, or MRI identifies the pathology (e.g., lung mass, hemothorax).
     • Pulmonary function tests (PFTs) assess lung capacity for elective cases.
     • Blood tests evaluate coagulation, hemoglobin, and organ function.
     • Bronchoscopy or esophagoscopy may be needed for cancer or esophageal cases.
   • IV fluids, antibiotics (e.g., cefazolin), and pain management stabilize the patient.
   • Patients are counseled on risks, including prolonged recovery and potential complications.
2. Surgical Techniques:
   
   • Posterolateral Thoracotomy:
     
     • Most common approach, used for lung or esophageal surgery.
     • Performed under general anesthesia with single-lung ventilation (via double-lumen endotracheal tube), lasting 2–4 hours.
     • The patient is positioned on their side (lateral decubitus).
     • An incision (15–20 cm) is made along the 5th or 6th intercostal space, curving under the scapula.
     • The ribs are spread with a retractor, and the lung is deflated to access the thoracic cavity.
     • Procedure-specific steps (e.g., lobectomy, esophageal repair) are performed.
   • Anterolateral Thoracotomy:
     
     • Used for trauma or cardiac access.
     • Incision along the 4th or 5th intercostal space, anterior to the mid-axillary line.
     • Faster access in emergencies (e.g., hemothorax, cardiac tamponade).
   • Median Sternotomy:
     
     • Vertical incision through the sternum, used for cardiac surgery or bilateral lung access.
     • Less common for isolated thoracic conditions but may be combined.
   • Procedure-Specific Steps:
     
     • Lung resection: Lobectomy or pneumonectomy for cancer, with lymph node sampling.
     • Trauma: Evacuation of hemothorax, repair of lung lacerations, or control of bleeding vessels.
     • Esophageal repair: Closure of perforation with tissue reinforcement (e.g., pleural flap).
   • Chest tubes (1–2) are placed to drain air/fluid post-surgery, and the incision is closed in layers (muscle, fascia, skin).
3. After Surgery:
   
   • Patients are monitored in the ICU for 1–3 days for pain, ventilation, and drainage.
   • Hospital stay: 5–10 days, depending on the procedure and complications.
   • Chest tubes are removed once drainage is minimal (<100–200 mL/day) and no air leak persists (confirmed by X-ray).
   • Pathology reports (for cancer) guide adjuvant therapy (e.g., chemotherapy, radiation).