Access to the thorax by incision

BACKGROUND: For years the standard access to the thorax has been by posterolateral or other muscle cutting thoracotomy incisions. These are accompanied by significant discomfort and often limitation of shoulder girdle movement. To obviate these distressing features, the less traumatic median sternotomy was recommended. In the last ten years, several types of mini or axillary thoracotomies have been described. We believe that the vertical axillary thoracotomy is the best of these incisions as no major muscles are divided, it can be created rapidly, and exposure is excellent. STUDY DESIGN: We compared the operative approaches from the point of view of the duration of postoperative hospitalization, the length of the operating time, the incidence of postoperative atelectasis, and persistence of incisional pain. RESULTS: The vertical axillary thoracotomy showed a definite advantage in all these categories. CONCLUSIONS: These findings suggest that the vertical axillary thoracotomy is the incision of choice for most thoracic procedures as the incision is small and quickly made. Because there is limited division of muscles, the convalescence is smooth and uncomplicated.