ABSTRACT
Modern approaches, strategies for less invasive means of managing thoracic pathology have continued to grow over the past two decades. Minimally invasive approaches are typically taught with the baseball diamond concept in mind. Prone positioning is advocated by some, in particular for the thoracic dissection during a minimally invasive esophagectomy. For minimally invasive chest wall resections in particular, operative planning and recognition of hindrances are critical to ensure success. The use of CO2 insufflation in chest surgery has become progressively more popular. Insufflation of CO2 during video-assisted thoracoscopic surgery (VATS) diaphragmatic plication allows for increased intrathoracic space, as the CO2 displaces the diaphragm inferiorly allowing for better visualization. Supine positioning for VATS is most commonly used for bilateral sympathectomy. Today, with less invasive approaches, positioning has become much more nuanced and is used to optimize muscle sparing and the minimally invasive approach. The anterior version can be adapted from the classic posterolateral position.
