Optimal exposure of thoracic inlet vascular structures: transmanubrial approach.

Exposure of the neurovascular structures of the thoracic inlet is limited by the bony thorax and clavicle. A cervicothoracic approach with resection of the medial one third of the clavicle or total claviculectomy provide excellent exposure but may render the patient with a significant cosmetic and functional defect. We describe a transmanubrial approach that preserves rigid fixation of the shoulder girdle and allows full access to the thoracic inlet. This technique is straightforward and may be easily modified to fit the particular needs of the patient, including access to the proximal brachiocephalic vessels, the hilum of the lung and the vertebral bodies of the lower cervical and upper thoracic spine.