1. Double transmanubrial approach and sternotomy for resection of a giant thymic carcinoid tumor 
Lorenzo Spaggiari, MD, PhD, Ugo Pastorino, MD 
The Annals of Thoracic Surgery 
Volume 72, Issue 2, Pages (August 2001)
DOI: /S (01)

2. Fig 1
Preoperative computed tomographic thoracic scan after chemotherapy. Note the mediastinal dislocation and vascular compression.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )

3. Fig 2
The planned skin incision. Right anterior thoracotomy was prepared in case of difficulties in removing the mass, but it was not used.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )

4. Fig 3 Cervical H-shaped skin incision.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )

5. Fig 4
Schematic representation of double transmanubrial osteomuscular sparing approach. (A) The continuous lines indicate the resection of the manubrium and of the first cartilage to lift the osteomuscular flaps. The dashed lines indicate the planned associated approaches. (B) The retraction of the osteomuscular flaps allows the opening of the space between the clavicle and the first rib and the safe control of the subclavian vessels.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )

6. Fig 5
(A) Schematic representation of Figure 5B. (B) The sternum is closed as reported in the text by using absorbable suture. The manubrium will be fixed with the same material.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )

7. Fig 6
Follow-up at 6 months. Note the absence of shoulder anatomical alterations; note the correct position of the sternomastoid muscles as well as of both clavicles.
The Annals of Thoracic Surgery  , DOI: ( /S (01) )