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Clemens Aigner
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J Thorac Cardiovasc Surg 2005;129:221-223
© 2005 The American Association for Thoracic Surgery

Brief Communications

Inverse T incision provides improved accessibility to the upper mediastinum

Gabriel Mihai Marta, MDa, Clemens Aigner, MDa, Walter Klepetko, MDa,*

a Department of Cardio-Thoracic Surgery, University Hospital of Vienna, Vienna, Austria

Received for publication January 27, 2004; revisions received March 26, 2004; accepted for publication April 6, 2004.

* Address for reprints: Walter Klepetko, MD, University Hospital of Vienna, Department of Cardio-Thoracic Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria (E-mail: walter.klepetko@meduniwien.ac.at).

The first 20% of the full text of this article appears below.

The choice of the appropriate incision for a thoracic surgical procedure is crucial for a successful operation and a satisfying postoperative functional result. Especially in oncologic surgery of advanced mediastinal tumors, the close contact to vital structures demands an optimal surgical field. This report presents an innovative new access as an alternative to the variety of already existing thoracic incisions.


   Clinical summary
 
A 59-year-old woman presented with exertional dyspnea and orthopnea and pronounced congestion of the jugular veins. Chest x-ray film showed a mediastinal widening. Computed tomography of the thorax revealed an anterior mediastinal mass with a diameter of 15.8 x 7.6 cm, with close contact to all major vessels and structures of the upper mediastinum and extension on both sides to the area of the phrenic nerves. However, radiologically, no signs of proved infiltration of vital structures were detected (Figure 1). The pulmonary function test revealed a moderate obstructive disease with a forced vital capacity of 2.19 L (68.1%) and a forced expiratory volume in 1 second of 1.53 L (59.4%). The histologic examination of tumor samples obtained by means of computed tomography–guided biopsy revealed the presence of a malignant mesenchymal fibrous tumor. Further . . . [Full Text of this Article]




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