Tenth Rib: Thoracoabdominal Approach

Abstract

1. Place the patient in the lateral decubitus position. Approach from the convexity of the scoliosis or from the left side when possible. A left-sided approach is preferred because of ease of mobilization of the aorta compared with the vena cava. In addition, splenic retraction is easier than hepatic. Incise the skin and subcutaneous tissue from the lateral border of the paraspinous musculature over the 10th rib to the junction of the 10th rib and costal cartilage.¹ Curve the incision anteriorly from the tip of the 10th rib to the lateral rectus sheath and distally down the edge of the sheath as far as necessary for exposure (Fig. 18A). Exteud the wound slowly through each muscle layer with the electrocautery. The assistant aggressively picks up bleeders with two Adson forceps.