The anterior scalene muscle was exposed and the medial cord of the brachial plexus (see brachial plexus anatomy) was encircled with a vessel loop and gently retracted laterally.
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The subclavian artery was encircled with a vessel loop and retracted medially (see subclavian vein access). The area was carefully explored, and the left phrenic nerve was not seen within the operative field, probably because of an aberrant course due to the variant anatomy. The anterior scalene muscle was carefully divided, exposing the first rib.
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