ABSTRACT
General surgeons need to know how to open the chest in an emergency. Those working in hospitals without cardiothoracic units may have to perform anything from a simple chest drain insertion to an emergency ‘clamshell’ thoracotomy in a patient who is too severely injured to allow stabilisation for transfer to a cardiothoracic unit. In the UK, most of the elective intrathoracic vascular and oesophageal surgery is now concentrated into tertiary referral centres. However, a vascular or upper gastrointestinal surgeon operating in the abdomen or neck may encounter unexpected pathology or an intraoperative complication that necessitates access to the thoracic aorta or oesophagus when this has not been anticipated preoperatively.
