Of all the regions within the abdomen the vault of the diaphragm is the most difficult of access, principally owing to the unyielding character of the lower portion of the thorax.
Various methods have been devised to overcome the difficulty. In cases of subphrenic and intrahepatic abscess or cysts of the convexity of the liver, one or more ribs have been resected, the pleural sac traversed or pushed up and drainage in a straight direction arranged for.
For the same purpose Lannelongue did resection of the eighth to the eleventh costal cartilages or of the respective ribs—a rather extensive additional operation.
Micheli1 worked out on the cadaver an operation similar to Schede's thoracoplasty. Of course, he avoids injury to the pleura and includes in the flap, diaphragm and parietal peritoneum. It seems that the operation was never done on the living subject.
While attempting to excise a carcinoma of
MEYER W. OSTEOPLASTIC RESECTION OF THE COSTAL ARCH IN ORDER TO REACH THE VAULT OF THE DIAPHRAGM.. JAMA. 1906;XLVII(14):1069-1075. doi:10.1001/jama.1906.25210140005001b