Posterolateral Thoracotomy

Abstract

The patient should be positioned on the contralateral side with the thoracic spinous processes vertically above the edge of the operating table so that the patient’s back is vertical. Sometimes a lateral support can assist with this, and on some occasions, lateral extension towards the contralateral side is desirable. The lower leg is flexed at both hip and knee and the upper leg is kept straight. The knees are separated by a pillow. A strap, carefully padded where it passes over the lateral aspect of the hip and buttocks, holds the lower half of the body in position (Fig. 8.1). A more rigid fixation is obtained if this strap passes over a pelvic support which is fixed anterior to the pubis. An anterior chest support is unnecessary, but additional fixation of the upper half of the body can be obtained by attaching the outer aspect of the upper arm and forearm to the operating table with adhesive plaster. The upper arm is flexed to a right angle at the elbow and sometimes more at the shoulder to rotate the scapula forward away from the midline.