What are the common approaches to the thoracic cavity?
The patient is positioned supine on the operating table. A midline skin incision is made from the jugular notch to the xiphisternum. Using monopolar diathermy this is then extended through the subcutaneous fat, being careful to remain in the midline until the sternum is reached. Blunt dissection with a finger is then used to clear tissues below the xiphisternum and around the top of the manubrium. The interclavicular ligament is divided with diathermy and the xiphisternum is cut with McIndoes scissors. The sternal saw is then used to divide the bone and a retractor is placed to expose the anterior mediastinum.
The patient is positioned prone or in a lateral position dependent on the structures to be accessed. A long parascapular incision is made, running from a point midway between the medial scapular edge and the thoracic spine and following a curve that runs 2 cm below the inferior scapular angle, to the midpoint of the axilla.