Editing Thoracotomy (section)

==Approaches==
There are many different surgical approaches to performing a thoracotomy. Some common forms of thoracotomies include:
* '''Posterolateral thoracotomy''' is the most common and traditional approach for gaining access to the chest. It is an incision through an [[intercostal space]] on the back, and is often widened with [[Retractor (medical)|rib spreaders]]. Patient has to be placed in a lateral decubitus position for this approach. All pressure points should be padded. A pillow should be placed between the two legs. Both arms should be flexed and maintained in "prayer position". A roll can be placed under the 5th intercostal space or the table can be broken at the same level so as to open the intercostal space widely for easy access.<ref>{{Cite journal | vauthors = Martin-Ucar A, Socci L |date=2017 |title=Thoracic incisions for open surgery |url=http://shc.amegroups.com/article/view/3819/4597 |journal=Shanghai Chest |volume=1 |pages=20 |doi=10.21037/shc.2017.05.11 |doi-access= free|url-access=subscription }}</ref> It is a very common approach for operations on the [[lung]] or [[posterior mediastinum]], including the [[esophagus]]. When performed over the fifth intercostal space, it allows optimal access to the pulmonary [[hilum of lung|hilum]] ([[pulmonary artery]] and [[pulmonary vein]]) and therefore is considered the approach of choice for pulmonary resection ([[pneumonectomy]] and  [[lobectomy]]). Another variant is the "muscle sparing posterolateral thoracotomy" which preserves the Lattisimus Dorsi and Serratus muscles. This leads to less shoulder dysfunction and also allows for these muscles for any future use in case of a complication.<ref>{{cite journal | vauthors = Ziyade S, Baskent A, Tanju S, Toker A, Dilege S | title = Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy | journal = The Thoracic and Cardiovascular Surgeon | volume = 58 | issue = 5 | pages = 295–298 | date = August 2010 | pmid = 20680907 | doi = 10.1055/s-0030-1249829 | s2cid = 260341562 }}</ref><ref>{{cite journal | vauthors = Li S, Feng Z, Wu L, Huang Q, Pan S, Tang X, Ma B | title = Analysis of 11 trials comparing muscle-sparing with posterolateral thoracotomy | journal = The Thoracic and Cardiovascular Surgeon | volume = 62 | issue = 4 | pages = 344–352 | date = June 2014 | pmid = 23546873 | doi = 10.1055/s-0033-1337445 | s2cid = 21882249 }}</ref>
* '''Anterolateral thoracotomy''' is performed upon the anterior chest wall. The skin incision is performed starting from the posterior axillary line in front of the tip of the scapula towards the submammary crease. The anterior intercostal spaces are wider as compared to the posterior spaces hence provide better exposure while minimising the need for excess rib spreading. It gives a very adequate exposure of lungs, pericardium and diaphragm. Left anterolateral thoracotomy is the incision of choice for open chest massage, a critical maneuver in the management of traumatic [[cardiac arrest]]. 
* '''Bilateral anterior thoracotomy with transverse sternotomy''', or clamshell incision, is the incision of choice for bilateral lung transplantation.<ref>{{cite journal | vauthors = Macchiarini P, Ladurie FL, Cerrina J, Fadel E, Chapelier A, Dartevelle P | title = Clamshell or sternotomy for double lung or heart-lung transplantation? | journal = European Journal of Cardio-Thoracic Surgery | volume = 15 | issue = 3 | pages = 333–339 | date = March 1999 | pmid = 10333032 | doi = 10.1016/s1010-7940(99)00009-3 | doi-access = free }}</ref> It is also a valuable tool in trauma settings.<ref>{{cite journal | vauthors = Germain A, Monod R | title = [Bilateral transversal anterior thoracotomy with sternotomy; indications and technics] | journal = Journal de Chirurgie | volume = 72 | issue = 8–9 | pages = 593–611 | date = 1956 | pmid = 13367123 | url = https://pubmed.ncbi.nlm.nih.gov/13367123 }}</ref> Large mediastinal tumours extending into both hemi-thorax and bilateral pulmonary tumours are also easily accessible via a clamshell incision.<ref>{{cite journal | vauthors = Bains MS, Ginsberg RJ, Jones WG, McCormack PM, Rusch VW, Burt ME, Martini N | title = The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor | journal = The Annals of Thoracic Surgery | volume = 58 | issue = 1 | pages = 30–2; discussion 33 | date = July 1994 | pmid = 8037555 | doi = 10.1016/0003-4975(94)91067-7 }}</ref>
* The [[Hutan Ashrafian|Ashrafian thoracotomy]]  was devised to give rapid access to the heart and pericardium through an incision that consists of an anterior thoracic incision followed in a vertical direction along the costo-chondral (rib-cartilage) junction.<ref>{{cite journal | vauthors = Ashrafian H, Athanasiou T | title = Emergency prehospital on-scene thoracotomy: a novel method | journal = Collegium Antropologicum | volume = 34 | issue = 4 | pages = 1449–1452 | date = December 2010 | pmid = 21874737 }}</ref>

Upon completion of the surgical procedure, the [[chest]] is closed. One or more [[chest tube]]s—with one end inside the opened [[pleural cavity]] and the other submerged under saline solution inside a sealed container, forming an airtight drainage system—are necessary to remove air and fluid from the [[pleural cavity]], preventing the development of [[pneumothorax]] or [[hemothorax]].