The technique, advantages, and disadvantages of a vertical axillary thoracotomy are discussed. This is a total muscle-sparing incision that allows adequate exposure of all intrathoracic structures. Postoperatively, there is excellent cosmetic healing and full shoulder girdle movement. The postthoracotomy pain also appears to be less. I prefer this approach for most routine thoracotomies, although I do not use it when chest wall resections or extremely difficult hilar dissections are anticipated.