There are several surgical procedures that require a Thoracotomy:

• Lung cancer surgery
• Esophageal cancer surgery
• Heart/aortic surgery
• Chest trauma
• Persistent pneumothorax 
• Treatment of COPD
• Tuberculosis
• Biopsy to evaluate tumors/growths in the mediastinum 
• Anterior spine surgery

Depending on the condition and type of surgery, there are several ways a thoracotomy can be performed such as:

• Postero-lateral thoracotomy - This is the most common and standard procedure to gain access to the lungs for lung cancer.
• Median thoracotomy – This procedure involves making an incision through the sternum to gain access to the chest. This procedure is commonly done to perform surgery on the heart.
• Axillary thoracotomy – This involves making an incision near the armpit. 
• Anterolateral thoracotomy - This procedure is usually used for emergencies involving an incision made in front of the chest.

There are several risks involved in a Thoracotomy. There may be a lot of loss of blood during the surgery. Infection may also occur at the site of incision. There are chances of air leaking out of the lungs which would require a chest tube after the surgery. Blood clots may form in the lungs or in the legs. The patient may suffer with Pneumonia after a Thoracotomy surgery. Rarely, arrhythmia and heart attack may occur.

After a Thoracotomy, the patient stays in the hospital for at least 4 days during which the blood pressure, heart rate and breathing is consistently monitored. All strenuous physical exercises must be avoided for at least 6 weeks after surgery.