Abstract
The rectus abdominis muscle is innervated by intercostal nerves T7-T12, and most thoracotomies are performed through the fourth to sixth intercostal spaces, so direct nerve damage to the rectus abdominis seems unlikely. However, at least one trocar is inserted below the seventh intercostal space in most multi-port video-assisted thoracoscopic surgeries (VATSs), and injury of the seventh or lower intercostal nerve with related paralysis of the rectus abdominis is possible, albeit rare. Only two cases of rectus abdominis paralysis caused by after VATSs have been reported, and these cases were not permanent injuries. This is the first report of permanent paralysis of the rectus abdominis after VATSs.