[Hook approach for radical resection of invasive apical lung cancer]

The hook approach provides safe identification and a wide view of subclavian vessels and branchial plexus on both their extra-thoracic and intra-thoracic aspects by a long skin incision resembling a "hook" and by tilting the table and moving the arm. The hook approach permits dissection of fat pad including supraclavicular lymph nodes from the same wound. This approach is suitable for invasive apical lung cancers without involvement of sternum. A patient with invasive apical lung cancer who received combined resection of the subclavian artery, vertebral artery, lower trunk of brachial plexus, (C8, Th1), third and fourth thoracic vertebrae, and first 4 ribs is presented and details of the hook approach is described.