Types of surgical incisions or skin wounds for pulmonary and mediastinal surgery

This used to be the standard approach for the pulmonary surgery. Now, it is not routinely used but depending on tumor characteristics. There are several possibilities:

• Posterolateral thoracotomy. It used to be the standard approach.

• Muscle-sparing thoracotomy. This type of wound avoids cutting big respiratory muscles while allowing a perfect access to the hemithorax

• Sterno-thoracotomy. This is an anterior wound that will help the surgeon dealing with upper tumors invading mediastinal structures and the most superior part of your lung

• Median Sternotomy. This wound is seldom performed but it can be useful for very large tumors in which central control of the large vascular structures is needed for a safe resection

In this case, the surgeon would open small incisions allowing the instruments inside the pleural cavity and he/she will operate on from outside the chest in direct contact with the patient or in a remote way (Robot Assisted Thoracic Surgery_ RATS) using high resolution camaras (4K, 3D technology) and special instruments.

It produces less pain, less bleeding and helps a faster recovery.  But this approach is not suitable for all tumors. Minimally invasive or VATS lung resections can be performed through one (Uniportal VATS), two or three incisions.