Towards the end of the 19th century, improvements in anaesthesia and asepsis allowed surgeons to contemplate operations in previously inaccessible areas. Abdominal and pelvic surgery could be performed on spontaneously breathing patients under deep ether or high spinal anaesthesia - but operating within the chest remained problematic. Opening the chest in a spontaneously breathing patient led to lung collapse, making all but the shortest operations impracticable. As surgeons applied themselves to this problem, several creative solutions were devised.
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