Enter the space from below by dividing the slips of the diaphragm arising from the xiphisternum and developing the space by blunt dissection, staying close to the back of the sternum
Pleura needs to be gently separated from the sternum by blunt dissection
Plane should be anterior to the thymus (and therefore brachiocephalic vein) but behind strap muscles and deep cervical fascia
Now create space from above by mobilising behind the manubrium
The two planes can be joined up by dividing the deep cervical fascia between them
Posterior sternoclavicular joints may need to be excised to create more space
Remove muscle fibres from medial clavicle
Free up costoclavicular ligament below and anterior sternocostal ligament in front
Sometimes remove half of manubrium and part of the first rib too
