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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "To limit postoperative morbidity, it is desirable and usually possible to employ a muscle-sparing approach, affording adequate exposure yet limiting or avoiding division of the serratus anterior and latissimus dorsi. The scapula is elevated off the chest wall by retractor to gain exposure, and palpation is used to count the ribs to the correct interspace. In most situations in infants, the highest palpable rib is the second. Generally, the fourth interspace is used for a lobectomy, although the fifth also can be used effectively."

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The breast tissue present in gynecomastia is most often tender, firm, and subareolar. One third of boys will present with unilateral gynecomastia. A mass in the breast that is not subareolar and is asymmetric should raise concern for other conditions. A testicular exam is a key component of the physical exam to rule out hypogonadism, suggestive of Klinefelter’s syndrome, a varicocele, or possible estrogen-secreting tumors of the testes, such as germ cell tumors, Sertoli cell tumors, or Leydig cell tumors."

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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "For routine lung biopsies or lung resections, the patient is placed in a standard lateral decubitus position, which provides for excellent visualization and access to all surfaces of the lung. This position is also the most beneficial set-up for decortications, pleurodesis, and other procedures in which the surgeon may need access to the entire pleural or lung surface. For anterior mediastinal surgery such as thymectomy, aortopexy, or biopsy, or for resection of anterior tumors or lymph nodes, a three-quarters posterolateral decubitus position should be chosen (Fig. 11.3). For posterior mediastinal surgery, including foregut duplications, esophageal atresia, and procedures involving the esophageal hiatus, a three-quarters anterolateral decubitus position should be used (Fig. 11.4). In addition, the patient can then be placed in Trendelenburg or reverse Trendelenburg as needed to help keep the lung out of the field of view."

reason for burning over second rib for 5cm laterally during thoracic sympathectomy, to burn The Nerve of Kuntz, to decrease recurrence post sympathectomy. recommendation is to burn over all ribs from 2 to 4, 5cm lateral to sympathetic trunk after its resection.