This is the skin incision for a left thoracoabdominal approach for a type IV or type III thoroabdominal aortic aneurysm open repair. The patient is on a left lateral position and the skin incision is on the top of the 9th rib. The approach is on the 8th intercostal space (between 8th and 9th rib).

The anterior part of the incision is along the lateral border of the sheath of the rectal abdominis muscle, down to about the mid-point between the umbilicus and the pubic symphysis. The posterior end of the incision is 2 finger-breaths under the angle of scapula. 

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