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Abstract Purpose  To evaluate the status of limited upper sternal split in general thoracic surgery. Methods  We reviewed the clinical files of 100 consecutive patients operated on through limited upper sternotomy at a hospital in Italy during the 10 years between January 1995 and December 2004. Results  Thymus surgery represented the main indication for this approach (n = 51): for myasthenia without thymoma in 28 patients, for thymus neoplasms with or without myasthenia in 22, and for intrathymic parathyroid adenoma in 1. Thyroid surgery constituted the second main indication for upper sternal split (n = 32) for benign retrosternal goiter in 18 patients, for mediastinal nodal metastasis of thyroid cancer in 11, and for malignant retrosternal goiter in 3. The remaining indications were as follows: to assess residual disease following chemotherapy for Hodgkin’s disease in 7 patients and for non-Hodgkin lymphoma in 1; for tracheal surgery in 7; and for excision of nodal mediastinal metastasis of non-thyroid cancer in 2. All operations were completed through the upper sternal split. There was no surgical mortality but complications developed in eight patients. Conclusion  The upper sternal split provides a satisfactory access to perform a surgical procedure in the superior mediastinum in most diseases. The procedure is safe and involves minimal surgical trauma. [ABSTRACT FROM AUTHOR]