title: Anterior minithoracotomy: a direct approach to the difficult hilum for upper lobectomy, pneumonectomy, and sleeve lobectomy.
abstract: BACKGROUND
  Central lung cancers with pulmonary hilar involvement can pose a technical challenge when a lateral thoracotomy is used. Proximal vascular control and pulmonary vascular dissection from this approach can be challenging and potentially dangerous. We describe the use of a Chamberlain anterior minithoracotomy as an alternative approach for safe and reliable access to the pulmonary hilum.
  
  
  METHODS
  One hundred two consecutive patients undergoing the Chamberlain approach were identified through retrospective chart review from 2002 to 2009. The supine position was used, thus reducing the likelihood of down-lung syndrome. An 8-cm anterior thoracotomy was performed over the second interspace along the line of the pectoral fibers, with preservation of the mammary artery medially and the thoracoacromial neurovascular bundle laterally. Primary outcome variables included hospital course, complications, and mortality rate.
  
  
  RESULTS
  The mean age was 64.8 years (range, 20-89 years). Sex ratio (female:male) was 44:58. Neoadjuvant therapy was used in 43 patients (42.2%). Proposed resections were successful in 101 (99%) of 102 patients. Conversion to hemiclamshell was required in 1 patient for vascular control. Three perioperative deaths (2.9%; two pneumonectomies, one lobectomy) occurred.
  
  
  CONCLUSIONS
  The Chamberlain mini anterior thoracotomy provides direct access to the pulmonary hilum, facilitating dissection and vascular control for large and central tumors. Reduced perioperative pain and down-lung syndrome compared to lateral approaches can be achieved. Muscle function is preserved, and intrapericardial/hilar access is expeditious. This approach enhances hilar access and avoids the vascular control and hilar exposure challenges inherent with lateral thoracotomy.
authors.affiliation: Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, Pennsylvania, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Pettiford
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: James R
authors.initials: JR
authors.lastname: Landreneau
authors.forename: Robert
authors.initials: R
authors.lastname: Jack
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Landreneau
authors.forename: David O
authors.initials: DO
authors.lastname: Wilson
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult