Key Points

• Numerous incisions are used in thoracic surgery.
• The goal of any approach is to optimize exposure of the surgical field and target tissues.
• A thorough understanding of the musculoskeletal anatomy of the chest wall is essential.

The history of thoracic surgery is replete with vivid descriptions of morbid, often gruesome, surgical approaches. The rigidity of the chest wall magnifies the importance of a well-conceived incision to facilitate exposure for procedures. A century of experience and technologic advancement has afforded the modern thoracic surgeon the luxury of choosing from a variety of surgical approaches to the chest. These are aimed not only to optimize access to the targeted pathology but also to limit morbidity and expedite recovery from the exposure itself. To successfully utilize this information, the surgeon must be facile with the surgical anatomy of the chest wall and contents, and must understand the advantages and limitations of each incision.