General: rightsided approach T7 and above, leftsided approach T8 or below

1
TRANSTHORACIC APPROACH

• General right-sided approach T7 and above,
  left-sided approach T8 or below
• Rib resection generally two levels above
  vertebrae of interest
• Divide latissimus dorsi and serratus anterior
  muscles
• Subperiosteal dissection and resection of rib

• Incise pleura longitudinally and reflect off
  vertebrae of interest
• Ligate segmental vessels crossing vertebral body
  if
• necessary

2
Skin incision for transthoracic approach.
3
(No Transcript)
4
LATISSIMUS DORSI MUSCLE
ANTERIOR SERRATUS MUSCLE
TERES MAJOR MUSCLE
INFRASPINOUS MUSCLE
SCAPULA
MAJOR RHOMBOID MUSCLE
TRAPEZIUS MUSCLE
The line of incision through the latissimus dorsi
muscle.
5
(No Transcript)
6
GREATER RHOMBOID MUSCLE
CUT EDGE OF LATISSIMUS DORSI
6th RIB EXPOSED
The periosteum over the rib to be resected is
divided and elevated.
7
(No Transcript)
8
PERIOSTEUM REFLECTED
LUNG
STUMP OF 6th RIB
The periosteum and costal pleura is incised,
exposing the pleural cavity.
9
(No Transcript)
10
LEFT LUNG
AORTA
THORACIC DIAPHRAGM
HEMIZYGOUS VEIN
INTERCOSTAL VESSELS
SYMPATHETIC TRUNK
The lung is retracted, exposing the posterior
mediastinum.
11
(No Transcript)
12
CUT BORDER OF PARIETAL PLEURA
ESOPHAGEAL PLEXUS OF VAGUS NERVES
ESOPHAGUS
THORACIC DIAPHRAGM
AZYGOS VEIN
5th RIB
INTERCOSTAL VESSELS AND NERVE
7th RIB
GREATER SPLANCHNIC NERVE
SYMPATHETIC TRUNK
Anatomy of the right posterior mediastinum.
13
(No Transcript)
14
THORACIC AORTA
HEMIZYGOUS VEIN
LEFT LUNG
DIAPHRAGM
10th RIB
INTERCOSTAL NERVES AND VESSELS
GREATER SPLANCHNIC NERVE
SYMPATHETIC TRUNK
Anatomy of left posterior mediastinum.