Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors
Section snippets
Technique
The skin incision is performed through an L-shaped cervicotomy with the upper line on anterior part of sternomastoid as far as the angle of manubrium and two fingers below the clavicle (Fig. 1). The sternomastoid muscle is dissected along its anterior part from cervical tissue up to internal jugular vein, the major pectoral muscle is spared, and the sternal manubrium is exposed (Fig. 2). The internal thoracic artery is divided and 25% of the superoexternal part of the manubrium (2 by 2 cm) is
Comment
At present, different anterior approaches for apical chest tumors have been proposed; ATA, proximal extended median sternotomy, and hemi-clamshell approaches have advantages and disadvantages, and all are worthwhile. Extended cervicosternothoracotomy, described by Masaoka and colleagues [[3]], and the hemi-clamshell technique described by Bains and colleagues [[4]] have some disadvantages. First, it is a difficult posterior dissection in the case of chest wall and vertebral invasion, and
References (6)
- et al.
Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet
J Thorac Cardiovasc Surg
(1993) - et al.
Anterior approach for tumor of the superior sulcus
J Thorac Cardiovasc Surg
(1979) - et al.
The clamshell incisionan improved approach to bilateral pulmonary and mediastinal tumor
Ann Thorac Surg
(1994)