An optimized retroperitoneal approach for open aortic repair by partially removing the tenth rib without incising the pleura and diaphragm

The ninth intercostal thoracoretroperitoneal incision is the most common approach for open repair of suprarenal abdominal aortic aneurysm or abdominal aortic dissection, which necessitates incision of the pleura and diaphragm and may lead to cardiorespiratory distress postoperatively. We optimized this approach by partially removing the tenth rib, bluntly dissecting the diaphragm from its costal edge, and retracting the diaphragm superiorly. We successfully performed this approach in three patients with pararenal abdominal aortic aneurysm, abdominal aortic dissection, or renal artery aneurysm. Based on our experience, this approach allows easy exposure of the suprarenal aorta and avoids thoracotomy, which would potentially benefit patients' prognosis.