It used to be quite common to do a thoracic approach about
ten years ago, but I don't think it's done that often now. They must have needed to let the esophagus down quite a bit and didn't want to do a Collis. Spreading the ribs causes a lot of trauma. Actually the docs who do the best work are still thoracic surgeons. The top ones often do re-do surgery laproscopically, but they won't promiss to not change and do
open or even thoracic once they get in there.