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Thor 02
1. TRANSTHORACIC APPROACH
1) General: right-sided approach T7 and above, left-sided
approach T8 or below
2) Rib resection generally two levels above vertebrae of
interest
3) Divide latissimus dorsi and serratus anterior muscles
4) Subperiosteal dissection and resection of rib
5) Incise pleura longitudinally and reflect off vertebrae of
interest
6) Ligate segmental vessels crossing vertebral body if
necessary
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.
6. CUT EDGE OF
LATISSIMUS DORSI
6th RIB EXPOSED
GREATER RHOMBOID
MUSCLE
The periosteum over the rib to be resected is divided and elevated.
7.
8. The periosteum and costal pleura is incised,
exposing the pleural cavity.
PERIOSTEUM
REFLECTED
LUNG
STUMP OF 6th RIB
9.
10. THORACIC
DIAPHRAGM
INTERCOSTAL
VESSELS
LEFT LUNG
AORTA
HEMIZYGOUS
VEIN
SYMPATHETIC
TRUNK
The lung is retracted, exposing the posterior mediastinum.
11.
12. AZYGOS
VEIN
5th RIB
ESOPHAGEAL PLEXUS
OF VAGUS NERVES
CUT BORDER OF PARIETAL PLEURA
ESOPHAGUS
THORACIC
DIAPHRAGM
7th RIB
SYMPATHETIC TRUNK
INTERCOSTAL
VESSELS AND
NERVE
GREATER SPLANCHNIC NERVE
Anatomy of the right posterior mediastinum.
13.
14. HEMIZYGOUS VEIN THORACIC AORTA
LEFT LUNG
DIAPHRAGM
10th RIB
GREATER SPLANCHNIC NERVE
SYMPATHETIC
TRUNK
INTERCOSTAL
NERVES AND
VESSELS
Anatomy of left posterior mediastinum.
