Small cervical incision facilitates minimally invasive resection of non-invasive thoracic inlet tumor

Nowadays, the thoracic inlet tumors still impose great challenges to thoracic surgeons due to their unique anatomic location in the thoracic inlet, where they were hidden behind the clavicle and first rib, and were close to important subclavicular vessels and brachial plexus (1). In order to obtain an excellent exposure, open approaches were conventionally applied either via a semi-clamshell incision or via thoracotomy in combination with sternotomy (2). However, these open approaches were associated with incisional trauma, significantly intensifying postoperative pain, increasing morbidity and yielding longer hospital stays (3). With the development of minimally invasive techniques, several studies (2-5) have focused on video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic inlet tumor. Although VATS minimizes incisional trauma, it was found to markedly increase the incidence of brachial plexus injury as compared with open approaches (5). Therefore, only a few skillful thoracic surgeons (2) are capable of accomplishing totally thoracoscopic resection of thoracic inlet tumors. As a result, whether the minimally invasive surgical techniques can be used in resecting the thoracic inlet tumor in a safer and easier way and how to do it are major clinical concerns