Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies

Median sternotomy – gold standard incision for cardiac surgeons

Sternotomy is the gold standard incision for cardiac surgeons but it is also used in thoracic surgery especially for mediastinal, tracheal and main stem bronchus surgery. The surgical technique is well established and identification of the correct anatomic landmarks, midline tissue preparation, osteotomy and bleeding control are important steps of the procedure. Correct sternal closure is vital for avoiding short- and long-term morbidity and mortality. The two sternal halves have to be well approximated to facilitate healing of the bone and to avoid instability, which is a risk factor for wound infection. New suture materials and techniques would be expected to be developed to further improve the patients evolution, in respect to both immediate postoperative period and long-term morbidity and mortality

The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathies

Mediastinoscopy is a diagnostic and/or therapeutic procedure through which it is realized visualization of the mediastinum contents, most times ending with a biopsy. Such procedure is often used in lung cancer for staging of the lymph nodes, or for a diagnosing purpose in several affections related to mediastinum (lymphoma or sarcoidosis). Morbidity is fairly low (0.2-0.5%), being encountered left recurrent laryngeal nerve injury, bleeding and pneumothorax. Contraindications are represented by previous mediastinoscopy, oncologic treatments (chemotherapy/ radiotherapy, due to development of mediastinal adhesions and fibrosis), or severe limitations in hyperextension of the neck (cervical arthritis, cutaneous tracheostomy). This paper presents the most important advantages and utility of mediastinoscopy, which proved during a long period of time to be safe, accurate and cost effective thoracic surgery technique. It minimizes the period of hospitalization and allows appropriate treatment to be immediately commenced upon diagnosis. Although there are a number of known complications of mediastinoscopy, it remains the ultimate diagnostic investigation for paratracheal and retrovascular enlarged mediastinal lymphnodes in centers where endo-bronchial ultrasound is absent or video assisted thoracoscopic surgery is not possible