- Skin incision and exposure
- Midline vertical incision from suprasternal notch to just below xiphisternum
- Dissect through fat and anterior rectus sheath
- Clear soft tissue from anterior surface of sternum
- Identify manubrium and xiphoid
- Sternal division
- Use a sternal saw to divide the sternum in the midline from xiphoid to the manubrium
- Take care to avoid cardiac injury on entry into the mediastinum
- Retraction and exposure
- Apply sternal retractor to separate the hemisternums
- Adjust to optimise exposure of mediastinal structures