TY - JOUR
T1 - The surgical anatomy and technique of the thoracoabdominal incision
AU - Lumsden, A. B.
AU - Colborn, G. L.
AU - Sreeram, S.
AU - Skandalakis, L. J.
N1 - Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 1993
Y1 - 1993
N2 - The thoracoabdominal incision provides excellent exposure of the thoracic, abdominal, and retroperitoneal compartments and can be safely performed in the vast majority of cases. To be more specific, the advantage of the left thoracoabdominal incision is excellent exposure of the lower esophagus, the gastroesophageal junction, the gastric cardia and stomach in toto, the left hemidiaphragm, the distal pancreas and spleen, the left kidney and adrenal gland, and the aorta. The advantage of the right thoracoabdominal incision is excellent exposure of the upper esophagus, the liver, the hepatic triad and inferior vena cava, the proximal pancreas, the right hemidiaphragm, the right kidney, and the adrenal gland. Several possible disadvantages should also be taken into consideration when contemplating this procedure. Morbidity and mortality may be increased with the opening of the two cavities. The surgeon must possess good detailed anatomic technique for opening and closure. This procedure is not advisable for children; it should be used only for good technical indications. Some of the more commonly encountered anatomic complications to be avoided include (1) splenic injury, occurring most often during division and resection of the diaphragm; (2) phrenic nerve injury, with subsequent diaphragmatic dysfunction; (3) ureteric injury during retroperitoneal dissection; (4) left first lumbar vein injury (located in the posterior aspect of the left renal vein) during left kidney mobilization; and (5) pain in the early postoperative period, which can occur secondary to transection of the cartilaginous costal arch. This may be minimized by secure fixation using No. 1 Prolene. Patients occasionally complain of a clicking sensation owing to nonunion of the costal cartilage.
AB - The thoracoabdominal incision provides excellent exposure of the thoracic, abdominal, and retroperitoneal compartments and can be safely performed in the vast majority of cases. To be more specific, the advantage of the left thoracoabdominal incision is excellent exposure of the lower esophagus, the gastroesophageal junction, the gastric cardia and stomach in toto, the left hemidiaphragm, the distal pancreas and spleen, the left kidney and adrenal gland, and the aorta. The advantage of the right thoracoabdominal incision is excellent exposure of the upper esophagus, the liver, the hepatic triad and inferior vena cava, the proximal pancreas, the right hemidiaphragm, the right kidney, and the adrenal gland. Several possible disadvantages should also be taken into consideration when contemplating this procedure. Morbidity and mortality may be increased with the opening of the two cavities. The surgeon must possess good detailed anatomic technique for opening and closure. This procedure is not advisable for children; it should be used only for good technical indications. Some of the more commonly encountered anatomic complications to be avoided include (1) splenic injury, occurring most often during division and resection of the diaphragm; (2) phrenic nerve injury, with subsequent diaphragmatic dysfunction; (3) ureteric injury during retroperitoneal dissection; (4) left first lumbar vein injury (located in the posterior aspect of the left renal vein) during left kidney mobilization; and (5) pain in the early postoperative period, which can occur secondary to transection of the cartilaginous costal arch. This may be minimized by secure fixation using No. 1 Prolene. Patients occasionally complain of a clicking sensation owing to nonunion of the costal cartilage.
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U2 - 10.1016/S0039-6109(16)46078-0
DO - 10.1016/S0039-6109(16)46078-0
M3 - Article
C2 - 8378814
AN - SCOPUS:0027301136
SN - 0039-6109
VL - 73
SP - 633
EP - 644
JO - Surgical Clinics of North America
JF - Surgical Clinics of North America
IS - 4
ER -