A Novel Approach to Resecting the First Rib Through A Posterolateral Thoracotomy for Apical Lung Tumours

A Novel Approach to Resecting the First Rib Through A Posterolateral Thoracotomy for Apical Lung Tumours | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Novel Approach to Resecting the First Rib Through A Posterolateral Thoracotomy for Apical Lung Tumours Marco Lizwan, Boon-Hean Ong, Mingjie Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8587850/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract We describe a novel technique to resect the first rib using a combination of video-assisted thoracoscopic surgery (VATS) and finger dissection. An elderly lady with left upper lobe adenocarcinoma invading the first rib was scheduled for surgery. Intraoperatively, a posterolateral thoracotomy was performed, followed by VATS dissection and blunt finger dissection to encircle the first rib safely. With the aid of a suture tied to a gloved fingertip, a Gigli saw was passed around the first rib and used to divide it distal to the subclavian artery. The first rib was then lifted off the underlying subclavian artery using a finger and safely dissected off the soft tissue. VATS camera was used to enhance visibility with the index finger encircling the rib. A left upper lobectomy was also performed through the posterolateral thoracotomy. This technique of first rib resection is safe and easily replicable. First rib resection chest wall resection thoracotomy hybrid surgical technique Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Apr, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 07 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 17 Jan, 2026 Submission checks completed at journal 17 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8587850","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":587406077,"identity":"0c29fbca-d613-412f-a500-5b9062299fe0","order_by":0,"name":"Marco Lizwan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYPACCx4w9YGBIcGASC0SYC2MM0jRAiaZeYjRott+9uGHDwwSMvIzkp89ts2xyTNnYH746AZDnV0DDi1mZ9KNJWcAHcY4I83cOHdbWrFlA5uxcQ7D4WScWg6ksQHdI8HDLJ1gJp277XDihgM8bNI5DAeScTnM7PwziBY26fRv0pYILXW4tdyA2sIjnWMmzYjQwmyHW8szZskZBhI8EvJvyiR7t6UlbjgM8ovB4QTcDktj/PChwsZevuf4Nomf22wSNxxvfvg4p6LOHpcWCECJC2aISGIDfj1YAAFbRsEoGAWjYAQBAG1ZSt2Tq4/cAAAAAElFTkSuQmCC","orcid":"","institution":"National Heart Centre Singapore","correspondingAuthor":true,"prefix":"","firstName":"Marco","middleName":"","lastName":"Lizwan","suffix":""},{"id":587406081,"identity":"f6b34ce2-a9f8-4b8b-8ef1-6b2d70deacd2","order_by":1,"name":"Boon-Hean Ong","email":"","orcid":"","institution":"National Heart Centre Singapore","correspondingAuthor":false,"prefix":"","firstName":"Boon-Hean","middleName":"","lastName":"Ong","suffix":""},{"id":587406083,"identity":"68d594de-d13d-4c63-b54f-9ab9ddd22b31","order_by":2,"name":"Mingjie Huang","email":"","orcid":"","institution":"National Heart Centre Singapore","correspondingAuthor":false,"prefix":"","firstName":"Mingjie","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2026-01-13 06:09:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8587850/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8587850/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102297873,"identity":"c5a77608-0ea5-41fc-af72-b9b09ee4a166","added_by":"auto","created_at":"2026-02-10 10:29:29","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":575118,"visible":true,"origin":"","legend":"","description":"","filename":"FirstRibExcisionJCTS.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8587850/v1_covered_e169543a-66b4-4410-a93e-4961616e679d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Novel Approach to Resecting the First Rib Through A Posterolateral Thoracotomy for Apical Lung Tumours","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"First rib resection, chest wall resection, thoracotomy, hybrid surgical technique","lastPublishedDoi":"10.21203/rs.3.rs-8587850/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8587850/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe describe a novel technique to resect the first rib using a combination of video-assisted thoracoscopic surgery (VATS) and finger dissection. 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