To perform extended lobar resection of the lung in cancer, thoracotomy from the lateral approach was used. Compared with the anterolateral approach, this access is more traumatic, it runs the risk of leaking pathological contents from the bronchi of the affected lung into a healthy one, special conditions and a mode of artificial ventilation during anesthesia, including taking into account the positional limitation of the mobility of the opposite side of the chest are required. However, at present, at the present level of anesthesia, which is constantly being improved, these shortcomings do not pose a serious danger. At the same time, lateral access significantly expands the possibilities of surgical action on mediastinal organs during surgical interventions for lung cancer, especially in patients with advanced stages of disease development.It provides full access to the preparation of regional lymph nodes in the lung in the interlobar fissure, within each of its lobes, in the root and mediastinum areas. If it is necessary to perform a bronchoplastic operation, lateral access creates the most convenient conditions for this. Lateral access in lung cancer should be considered as responding to the greatest extent to the task of performing all variants of radical, expanded surgical interventions in the vast majority of patients with advanced stages of disease development.Lateral access in lung cancer should be considered as responding to the greatest extent to the task of performing all variants of radical, expanded surgical interventions in the vast majority of patients with advanced stages of disease development.Lateral access in lung cancer should be considered as responding to the greatest extent to the task of performing all variants of radical, expanded surgical interventions in the vast majority of patients with advanced stages of disease development.

The technique of performing lateral access in the IV or V intercostal space is described in detail in numerous manuals on pulmonary surgery. It should be noted that to ensure the most convenient access to the deeply located parts of the regional lymphatic collector of the lung within the mediastinum: it is advisable to use two retractors to perform a wide lymphadenectomy (Fig. 19). Complicated situations: with pronounced adhesions in the pleural cavity, paracancrosis changes, etc. It is acceptable to intersect the cartilage of one or two ribs, as is done with anterior-lateral thoracotomy. This provides a good overview of the anatomical structures and organs of the mediastinum, creates the possibility, without risk for the patient, to perform a wide removal of the lymph nodes and tissue of the mediastinum while maintaining most of the lung tissue that is not affected by the swelling .

With regard to the implementation of advanced combined resection of the lungs, each of the operative accesses has its advantages and disadvantages, which can either make it difficult or significantly facilitate the implementation of surgical intervention.

The main advantages of anterior-lateral access are: the possibility of a broad view of the entire anterior and lateral surface of the lung, the best approach to the vessels of the lung root, superior vena cava, less invasiveness, and the ability to expand operative access by crossing the cartilage above or below the underlying ribs. It creates the best conditions for the operation during germination of the anterior surface of the pericardium, involvement of the anterior or anterior-lateral wall of the superior vena cava, pulmonary artery into the tumor process. The main disadvantages of access include the difficulty of manipulating the localization of the tumor in the posterior-medial regions of the lungs with the germination of the organs of the posterior mediastinum, the posterior surface of the pericardium and the pulmonary vessels, the inability to operate on the bronchi before the ligation of the pulmonary vessels,the complexity of performing mediastinal lymphadenectomy, requiring constant cardiac traction. Certain discomforts arise when a tumor grows into the diaphragm.

Most meet the objectives of surgical treatment with advanced stages of lung cancer lateral access. With him provides a broad overview of almost all departments of the thoracic cavity, it is possible to manipulate both from the back and from the front surface of the root of the lung, which ensures an approach to the lung vessels and bronchi. The access to the pectoral access is conveniently performed by resection of the tracheal wall, and from the right-hand side — and bifurcation. It provides a broad approach to the organs of the posterior mediastinum, the most convenient and safe in cases of suspected tumor lesion of the descending part of the aorta. With lateral access, there is a broad approach to the main interlobar fissure, and mediastinal lymphadenectomy is greatly simplified. The main disadvantage is the high invasiveness of the lateral access, since this requires a wide intersection of the muscles of the lateral and posterior surface of the chest. Sparing access options,in which the latissimus dorsi muscle does not intersect, but stretches with the help of a retractor, when performing extended combined resections of the lungs are not advisable, because manipulations at the root of the lung have to be done at great depth, in conditions of a narrow operative field, which, when large vessels are involved in the tumor process, the heart walls significantly increase the risk of surgery.

The use of posterior-lateral access to perform extended combined resections of the lungs is less justified. Its advantage is convenience in manipulations on the main bronchi, and from right-hand access and on the trachea bifurcation. However, it makes it difficult to approach the vessels of the lung root, superior vena cava, the lateral and anterior surface of the pericardium, the diaphragm, and the aorta. It is technically difficult to perform mediastinal lymphadenectomy from the posterior-posterior approach, especially in left-sided thoracotomy.

Bilateral front-side access with transverse sternotomy for advanced stages of lung cancer, as a rule, does not apply. In rare cases, mainly with the development of complications, there is a need to expand operative access for anterior-lateral thoracotomy by transverse sternotomy.