It is possible to gain postero-lateral access to the thorax through the auscultatory triangle, without dividing any of the major chest wall muscles. Appropriate mobilisation of the muscles allows full access, through which a full range of thoracic procedures can be performed. The incision preserves full serratus anterior and latissimus dorsi muscle function. This has theoretical advantages in patients with borderline respiratory function (these being secondary muscles of respiration). Unfortunately, the group of patients who most benefit from preservation of muscle function, manual labourers, often have such well developed muscles, that adequate access is difficult through this incision.

Posterior muscle sparing thoracotomy