Q: Dr. Eppley, I’m interested in rib removal. I was wondering how much of the 11th and 12th ribs you remove during the procedure? Also, what is the risk of post-thoracotomy pain from the procedure? And what do you do with the intercostal nerves that run below the ribs when you do this procedure? Thanks very much.
A: In answer to your rib removal questions, the ribs are removed back to the lateral or outer border of the erector spine muscles. More medial resection towards right spine has no aesthetic benefit. There is zero risk of pneumothorax in removing ribs #11 and #12. The pleura of the lung sits higher than at these rib levels in most patients. I have only see the pleura one time during surgery at the level of the 11th rib. The intercostal neurovascular bundle, located on the inferior side of the rib in a bony groove, is dissected out and preserved throughout the extent of the rib resection out to their cartilaginous tips. Intercostal nerve blocks with Exparel anesthetic are administered at the end of the procedure prior to wound closure to help with decrease the immediate postoperative pain during the first few days after surgery.
Dr. Barry Eppley