Thoracic spine – anterior approach

* position – lat. with bean bag

* incision
– usu R sided approach
– 1/2way btw spine & scapula –> ant. axillary line
– 2 ribs above level wanting to be accessed

* dissection
– divide lat. dorsi in line with skin
– divide serratus ant. in line with skin down to rib
– expose rib subperiosteally
– resect rib as far post. as possible
– nick pleura with knife
– enter pleura bluntly
– deflate lung & retract ant.
– identify esphagus
– incise pleura over lat. sid of esophagus & retract
– tie off intercostal vessels (avoid if possible due to blood supply to SC)

* dangers
– intercostal vessels
> during rib resection
> during exposure of vert. body
– lung

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