The modified "hemi-clamshell" approach for tumors of the cervicothoracic junction

The anterior approaches proposed for treatment of the apical chest tumors ( anterior transcervical, transmanubrial, and hemi-clamshell) have precise ad vantages and limits. To avoid these limits we have modified the hemi-clamsh ell with the resection of the first costal cartilage and the costoclavicula r ligament. This allows a wider opening of the sternocostal nap, with safe control of the entire subclavian vessels as well as easier access to the T1 to T3 vertebral bodies and the posterior chest (C) 2000 by The Society of Thoracic Surgeons.