Anterior approach for tumor of the superior sulcus

A new approach for the resection of tumors of the superior sulcus is described. The exposure is gained through a proximal median sternotomy extended into the anterior fourth intercostal space as well as to the base of the neck on the appropriate side. This approach guarantees excellent exposure of the tumor, subclavian artery, and brachial plexus as well as access to the ribs posteriorly and the border of the vertebral bodies. Hilar dissection is readily accomplished without change of the patient's position. Disadvantages relate to depth of exposure, especially in large individuals, and the complicated wound closure.