Anterior chest wall lifting methods for mediastinal approach—literature review

Abstract

Background and Objective For the purpose of facilitating a wide view and working space during surgery such as a thymectomy procedure, as well as that for treatment of anterior mediastinal lesions, anterior chest wall lifting began to be employed. In this article, previous reports of various kinds of chest wall lifting methods are reviewed. Methods The present study focused on procedures used for anterior chest wall lifting in a review of related studies primarily available in English. A search of the PubMed database was conducted in 1st March 2016. The first description about lifting method was reported in 1988. Key Comments and Findings Although objective evaluation regarding the effectiveness of lifting is difficult, in view of a balance among safety, reliability, and minimal invasiveness, surgeons may consider chest wall lifting as an optional method. Conclusions Anterior chest wall lifting began to be employed for enlarging the working space long before the advent of endoscopic surgery. Some originally developed retractors were used in transcervical thymectomy procedures. After general acceptance of transsternal extended thymectomy for myasthenia gravis, these transcervical approaches remained an important option along with anterior chest wall lifting. Thoracoscopic surgery for the treatment of anterior mediastinal lesions was introduced in the 1990s. Particularly in cases of surgery in the supine position, various creative methods and devices of lifting the sternum body, the anterior part of the rib, or the xiphoid process were reported.