Introduction: Resection of giant teratomas can be challenging. An advanced surgical technique should be designed to ensure surgical safety and complete removal of giant teratomas. We describe a case of a mature giant teratoma successfully resected with a clamshell incision thoracotomy approach. Case Description: A female, 11 years complained of shortness of breath for the last two weeks before being admitted to the hospital.  Physical examination revealed a retraction of the patient's chest wall, decreased breath sounds in the left lung field, and dull percussion in the left lung field. Chest CT scan with contrast was carried out with a minimal right pleural effusion with mediastinal mass size 14 x 17 x 16 cm. The patient underwent surgery to extract the mediastinal mass; an anterior thoracotomy was performed using the Clamshell incision method on the patient's chest. Complete resection of the mass was performed. Histopathology examination was performed on the mass with the results in accordance with the description of Mature Cystic Teratoma. The patient returned home in good condition and then controlled through the outpatient polyclinic. Discussion: Clamshell incisions provide enough exposure for tumors in the mediastinum that extend into the thoracic cavity. For complete removal of a gigantic teratoma, extensive surgical and visual fields are required, as in this case. Conclusion: Clamshell incisions in anterior thoracotomy give a good surgical field and can be safely performed in patients with large mediastinal teratomas.

The goal of this study was to identify vascular access in patients undergoing emergency hemodialysis in outlying areas at RSU NTB. This study, which was conducted concurrently from secondary data of patients with chronic kidney disease (CKD) who needed emergency hemodialysis through a temporary non-tunnel double-lumen vascular catheter access at the West Nusa Tenggara Regional General Hospital from May 2019 to May 2022, is a quantitative descriptive study using a cross-sectional approach. by including 331 research participants, the majority of them were between the ages of 46 and 55 (n=31.4%), with a male to female ratio of 54.4% to 45.6%. According to this study, hypertension, which affected 158 individuals (n=47.7%) of the research subjects, was the most prevalent ailment. As many as 122 patients (n=36.9%) with chronic kidney disease (CKD) who have hemodialysis grounds report shortness of breath as their primary complaint. Emergency hemodialysis, which involved 295 patients (n=89.1%) of patients with chronic kidney disease, was the most common reason for hemodialysis, followed by chronic or regular hemodialysis, which involved 30 patients (n=9.1%). In conclusion, comorbidities and clinical symptoms were taken into account when deciding the type of hemodialysis that will be administered.