Design variations in vertical muscle-sparing thoracotomy

Open thoracotomy continues to be the gold standard approach for thoracic surgery despite the recent developments in thoracoscopic and robot-assisted procedures. Vertical muscle-sparing thoracotomy (VMST) is a well-established technique (1-3) that has not attracted much attention in recent years. Surgeons often regard VMST as an anterior approach; however, it actually allows wide access to even the ventral and dorsal aspects of the thorax. In this paper, we discuss the variations in VMST, mainly with respect to the incision design, which have not been fully discussed to date. By its optimal incision design, VMST balances optimal skeletal muscle preservation with favorable exposure of various thoracic structures, including the dorsal aspect. We enumerate these VMST variations used in our practice, briefly discuss the basic but important procedures, and hope that our report will assist general thoracic surgeons, particularly the young trainees and residents, in advancing their clinical skills