Objective The aim of the study was to evaluate the use of vertical thoracotomy as a thoracic approach. Background A carefully planned thoracic incision should provide effortless and excellent exposure, preservation of the underlying anatomy and function, and a cosmetically acceptable result. Materials and methods We conducted a prospective, cohort study in which 30 consecutive patients were exposed to two types of thoracotomies performed by the surgeons of the cardiothoracic surgery Department in Menoufia University Hospital from October 2012 to October 2014. The patients were classified randomly into two groups: group A (n = 15) in which vertical thoracotomy was performed and group B (n = 15) in which standard posterolateral thoracotomy was performed. Operative data were collected from all patients in both groups as regards indication of operation, type of operation, intraoperative complications such as bleeding, need of extension of the incision, total operative time, and time of opening and closure of the thoracotomy. Results Results showed that vertical thoracotomy can be used for a wide range of procedures in different age groups and in both sexes. Shoulder joint movement was significantly better when vertical thoracotomy was used (P = 0.044), and cosmetic results are better. Conclusion Vertical thoracotomy offers specific advantages of minimum trauma and maximum preservation of chest wall function with a cosmetically acceptable scar.