Morphometric analysis of the thoracic cage in adults: Anatomical considerations in relation to neurosurgical thoracoscopic procedures

Abstract

Study Design: Direct measurements of the adult human intercostal spaces and depths of thoracoscopically accessible anatomical structures from common entrance points on the posterior axillary line for thoracoscopic tools. Objectives: To determine morphometry of the adult human chest wall and thoracic cavity that can be utilized during thoracoscopic procedures and in thoracoscopic tool design. Background Data: Although certain entrance points through the intercostal spaces are recommended for thoracoscopy, no anatomical data have been tabulated in the literature quantifying distances from these entrance points or investigating variability among subjects. Materials and Methods: Direct measurements of the intercostal spacings of 10 unembalmed cadavers were obtained. Distances between the 1st-10th rib at the posterior axillary line and the caput of the corresponding ribs and the junction of the lateral edge of the aorta and the intervertebral disc were measured. Results: Intercostal spacings gradually increased from rostral to caudal and were maximum at T10-11 (mean 15.2 mm). Distance from the posterior axillary line to the caputs of the corresponding ribs was greatest at the 7th rib (mean 11.4 cm). Distance from the posterior axillary line to the junction points of the corresponding intervertebral discs and aorta was greatest at the 7th rib level (mean 12.6 cm). Conclusion: These data provide a quantitative anatomical basis that can be used to help limit neural and vascular complications during thoracoscopy, improve thoracoscopic techniques, design new thoracoscopic equipment, and compare to the anatomy of the animals used for thoracoscopic training.