Voies d'abord chirurgicales antérieures du thorax

Anterior surgical approaches of the chest are mainly used for cardiac surgery with cardiopulmonary bypass, mediastinal surgery, and lung and heart-lung transplantation. For years, posterolateral thoracotomy has been considered as the approach of choice to deal with pulmonary resection, while bilateral anterior thoracotomies with transverse sternotomy (clamshell incision) was historically the approach for cardiac surgery. Around 1957, clamshell incision was replaced by median sternotomy popularised by Julian. Development of video-assisted thoracic surgery around 1990 allowed to review surgical approaches, so minimal access with minor parietal injuries gain success. However, in the same period, clamshell approach was reintroduced by Cooper et al 1990 to facilitate access for double lung transplantation. In this article, the authors present different aspects of anterior surgical approaches of the chest : median sternotomy, anterolateral thoracotomy, anterior mediastinotomy, transsternal bilateral thoracotomy (clamshell incision), sternotomy and lateral thoracotomy (hemi-clampshell incision). Technical aspects in detail as well as indications, pitfalls, and complications are described through a strikingly illustrated text.