Morbidity and validity of the hemiclamshell approach for thoracic surgery

Objective: This is a prospective study to evaluate the indications and outc ome of the hemiclamshell incision (longitudinal partial sternotomy combined with an antero-lateral thoracotomy) as used for a consecutive series of pa tients requiring surgery for various thoracic pathologies not ideally appro ached by postero-lateral thoracotomy, sternotomy or thoracoscopy. Methods: All patients with a hemiclamshell incision performed between 1994 and 1998 were prospectively analyzed regarding indications, postoperative morbidity and outcome (clinical examination and pulmonary function testing) in order to validate this incision for thoracic surgery. Results: 25 patients (15 me n, 10 women) with an age ranging from 16 to 73 years (mean 43 years) underw ent a hemiclamshell incision. The indications for the hemiclamshell approac h were (1) chest trauma with massive hemorrhage requiring urgent access to the mediastinum and the ipsilateral pleural space (40%), (2) tumors of the anterior cervico-thoracic junction with suspicion of vascular involvement ( 28%) and (3) lesions involving both one chest cavity and the mediastinum (3 2%). The 30-day mortality was 8%. One patient suffered a sternal wound infe ction, mediastinitis and pleural empyema after a gun shot wound, whereas wo und healing was uneventful in all other patients. Analgesic requirements fo r postoperative pain relief were not increased as compared to those followi ng a standard thoracotomy. At 3 months normal sensitivity of the entire che st wall and intact shoulder girdle function was noted in 90% of the patient s. Pulmonary function testing showed no restriction due to the hemiclamshel l incision. Conclusions: The hemiclamshell incision is a useful approach in selected patients and does not cause more morbidity or long-term sequelae than a standard thoracotomy. (C) 1999 Elsevier Science B.V. All rights rese rved.