Elective anterior and posterior thoracotomies

While seldom used in contemporary surgery, this incision provides a direct access to the tracheobronchial tree and the main stem bronchi. The posterior approach in the prone position has been formerly designed to operate on patients with copious secretions originating from suppurative processes such as bronchiectasis or lung abscess. Dumbbell tumors have been the indication of choice for a long time. The approach of Paulson is completely satisfactory in dealing with posteriorly located tumors of the superior sulcus, although it is not fully adequate in the presence of invasion of anteriorly located structures such as subclavian vessels. This indication has been substituted with development of anterior approaches, and more specifically cervicosternothoracotomy or hemiclamshell incisions w1x.