No one is going to thank you for leaving fewer or smaller wounds on a corpse – leave your handbook of minimally invasive and aesthetic technique at home – this is not boutique surgery. Also, don’t get confused – we are not here to cure cancer or treat congenital or age related cardiovascular disease. That stuff you will find in the handbook of elective cardiothoracic surgery. That all applies where the specialized and circulatory-supported are the only surgeons regularly entering the chest. We are going to a place where the general surgeon is likely the only hope a patient has for surviving after a thoracic wound. That hope will be vested in you. Fortunately it is also a place where the experienced general surgeon is likely to know a lot about the priorities and pitfalls of thoracic surgery for trauma. But the rub is that even among seasoned trauma and combat general surgeons, there is limited (though highly intense) individual experience. It’s a very difficult area in which to get a wealth of experience because only a small minority of thoracic injuries, even penetrating or combat related, require a major operation. In those that do require an operation the stakes are extremely high.