A standard posterolateral thoracotomy with division of the latissimus dorsi and serratus anterior muscles is associated with an important postoperative morbidity. A vertical axillary thoracotomy combining a vertical axillary skin incision with an intermuscular approach sparing both latissimus dorsi and serratus anterior muscles has the advantage of allowing full shoulder girdle motion early postoperatively as well as masking of the scar by the upper arm at rest. We report our experience with nine patients operated on with this approach for various intrathoracic lesions. All procedures were carried out without major difficulties. Wound healing was excellent in all patients. No infection nor seroma formation was seen with a submuscular suction drain. All patients had early and full shoulder girdle movement. No patient complained of late post-thoracotomy pain. We conclude that a vertical axillary thoracotomy provides an excellent cosmetic and muscle sparing incision which can be utilized for many thoracic procedures. However, we believe that, in the near future, video-assisted thoracoscopic surgery will become more popular than open thoracotomy for certain indications because of its distinct advantages of less postoperative morbidity.