The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters

Background. Different alternative approaches to thoracotomy have been developed because of the considerable morbidity associated with the standard posterolateral incision. Methods. We studied a prospective, randomized, blinded study of 60 consecutive patients to compare surgical approcah time, postoperative pain (quantitated by narcotic requirements and the visual analogue scale), pulmonary function, shoulder strength, and range of motion between standard posterolateral (group I) and muscle-sparing (group II) thoracotomy techniques. Results. There were no differences in postoperative surgical time, pulmonary function, shoulder range of motion, mortality, or hospitalization time. There was significantly less postoperative pain in group . In this group, narcotic requirement was less in the first 24 hours, and visual analogue scale scores were significantly lower (p < 0.05) throughout the first postoperative week. Muscle strength had returned to preoperative levels by 1 month in both groups. Morbidity was identical in the two groups with the exception of postoperative seromas. The prevalence of serorna was 16.6% in the musclesparing group. Conclusions. We conclude that the muscle-sparing incision may be a sensible alternative to a standard posterolateral thoracotomy. (C) 2003 by The Society of Thoracic Surgeons.