04 / Anatomy · Approaches
The ways in
An approach is anatomy with a direction: the ordered list of what lies between skin and target, and why that particular door was chosen. Descend each one a layer at a time, the hazards print at their own depth, and the operations that use the door wait at the bottom.
Abdomen
Midline laparotomy
layer 1 / 5
The emergency's incision: fast, bloodless in the right plane, extensile from xiphoid to pubis, and it commits to nothing before the abdomen has told its story.
01Skin
Vertical, around the umbilicus, along the visible midline.
Right iliac fossa
Lanz / McBurney (grid-iron)
layer 1 / 5
The appendix's own door: centred on McBurney's point, splitting each muscle layer along its fibres rather than cutting any of them.
01Skin
Lanz: transverse in the skin crease, the cosmetic evolution of McBurney's oblique cut.
Right upper quadrant
Kocher subcostal
layer 1 / 4
The open biliary incision: parallel to and two fingers below the costal margin, aimed straight at the gallbladder bed and porta.
01Skin
Oblique, following the costal margin.
Suprapubic
Pfannenstiel
layer 1 / 4
The low transverse incision of pelvic surgery: cosmetic, strong, and directly over the bladder, uterus and prostate's front doors.
01Skin
Transverse, two fingerbreadths above the pubis, inside the future waistband.
Thorax
Median sternotomy
layer 1 / 4
Cardiac surgery's front door: the whole heart and great vessels displayed through one bone cut in the midline.
01Skin & subcutaneous tissue
Midline, suprasternal notch to below the xiphoid.
Thorax
Posterolateral thoracotomy
layer 1 / 4
The open chest for lung surgery: a curved incision below the scapular tip entering usually the fifth interspace.
01Skin
Curved from anterior axillary line, below the scapula tip, toward the spine.
Hip
Posterior approach to the hip
layer 1 / 4
Arthroplasty's workhorse: excellent femoral and acetabular exposure through a plane that spares the abductors.
01Skin
Curved over the greater trochanter, along the femur below, toward the posterior iliac spine above.
Neck
Anterior cervical (collar) approach
layer 1 / 4
Thyroid and parathyroid surgery's door: a transverse crease incision and a bloodless midline between the strap muscles.
01Skin & platysma
Collar incision in a crease two fingerbreadths above the notch; platysma divided with the skin flap.