title: Extended Chamberlain minithoracotomy: a safe and versatile approach for difficult lung resections.
abstract: BACKGROUND
  We present the perioperative outcomes of patients undergoing an anterior "extended Chamberlain" minithoracotomy as an alternative approach to a hemi-clamshell sternotomy or extended lateral thoracotomy for safe and reliable access to the pulmonary hilum and subsequent anatomic pulmonary resection.
  
  
  METHODS
  This study is a retrospective review of 162 patients undergoing anatomic lung resection through a mini anterior thoracotomy from 2002 to 2010. An 8-cm anterior thoracotomy was performed with the patient in a supine position, entering the chest through the second intercostal space. The pectoralis muscle fibers were split 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 63.9 (range, 20 to 85 years); female to male ratio was 71:91. Neoadjuvant therapy was used in 49 (30.2%) patients. Proposed resections were successful in 161 of 162 (99%) patients. Conversion to hemi-clamshell was required in 1 patient for vascular control. Complications occurred in 48 (29.6%) patients. Three (1.9%) perioperative deaths (2 pneumonectomies [6.3%], 1 lobectomy [1.0%]) occurred. Median length of stay was 8 days.
  
  
  CONCLUSIONS
  The "extended Chamberlain" mini anterior thoracotomy provides direct and expeditious, less-invasive access to the pulmonary hilum. This approach preserves muscle function and avoids partial sternotomy or extended lateral thoracotomy, and their associated incisional-related morbidity.
authors.affiliation: Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA. schuchertmj@upmc.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: André P
authors.initials: AP
authors.lastname: Souza
authors.forename: Ghulam
authors.initials: G
authors.lastname: Abbas
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.forename: Robert
authors.initials: R
authors.lastname: Jack
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Horne
authors.forename: James R
authors.initials: JR
authors.lastname: Landreneau
authors.forename: Marco
authors.initials: M
authors.lastname: Santana
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; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D056888:Patient Positioning; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016683:Supine Position; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult