Initial experience in uniportal subxiphoid video-assisted thoracoscopic surgery for major lung resections

Hernandez-Arenas, Luis Angel; Lin, Lei; Yang, Yang; Liu, Ming; Guido, William; González-Rivas, Diego; Jiang, Gening; Jiang, Lei

doi:10.1093/ejcts/ezw189

Cited by 74 publications

(77 citation statements)

References 17 publications

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“…Nonetheless even small chest wall incision cause intercostal neuralgia and can result in chronic thoracic pain. The subxiphoid approach is a novel technique which is only performed in a select number of centres worldwide but its use has been described in a variety of cardiothoracic operations including pericardial window creation, coronary artery bypass surgery, thymectomy, lobectomy and pulmonary wedge resections (5)(6)(7)(8)(9)12).…”

Section: Discussionmentioning

confidence: 99%

“…This has the potential benefit of reducing post- operative pain and allows for early aggressive mobilization and clearance of secretions with the benefit of reducing the incidence of venous thromboembolism and lower respiratory tract infection (6). Earlier mobilization may also facilitate reduced length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has evolved to the use of bilateral uniportal VATS requiring one incision on either side to perform pleurectomy and bullectomy (3,4). Recently, to further minimise the surgical impact, a select number of centres has adopted the uniportal subxiphoid VATS (SVATS) technique which could offer several advantages including reducing acute and chronic postoperative pain by avoiding damage to the intercostal nerves, with consequential benefit in terms of recovery and quality of life (5)(6)(7)(8)(9). The ability to access both pleural cavities using a single incision is a further advantage of uniportal subxiphoid VATS which can be utilized in the management of patients with can bilateral pneumothoraces.…”

Section: Introductionmentioning

confidence: 99%

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Subxiphoid approach for spontaneous bilateral pneumothorax: a case report

et al. 2017

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An 18-year-old man presented to the Emergency Department (ED) with sudden onset chest pain and a nonproductive cough. He had no significant past medical history or underlying pulmonary disease and there was no history of trauma preceding the onset of symptoms. On admission the patient was dyspnoeic and had decreased breath sounds over the right hemithorax. He was haemodynamically stable with oxygen saturation of 94% on room air. Complete blood count and biochemistry results were within normal Abstract: The development of video-assisted thoracoscopic surgery (VATS) has contributed to reduced pain and improved recovery following thoracic surgery. However, pain remains a major issue. Patients with bilateral pulmonary pathology requiring operative intervention may have even more pain due to bilateral transthoracic incisions. The recently described uniportal subxiphoid VATS approach provides an opportunity to undertake bilateral thoracic surgery through a single incision that avoids the bilateral intercostal nerve damage caused by transthoracic incision and drainage. Here we report a case of a patient requiring bilateral bullectomy and pleurectomy for the management of pneumothorax that was performed successfully by the subxiphoid VATS approach. limits. A chest radiograph demonstrated a large right sided pneumothorax which was treated with insertion of a 14 Fr Seldinger chest drain and resolved spontaneously during a 2-day admission and he was discharged home. One month later he presented to the ED with similar symptoms and at this time chest radiography demonstrated a left sided pneumothorax which was treated with insertion of a 14 Fr Seldinger chest drain but had a persistent air leak. Chest computed-tomography (CT) revealed multiple subcentimeter blebs of variable size in the apical portion of both lungs. He was referred to our tertiary cardiothoracic centre for consideration of surgical treatment. Patient selection and workupIndications for thoracoscopic pleurectomy and bullectomy include patients following a second ipsilateral spontaneous pneumothorax or a first contralateral pneumothorax. Other patients who warrant consideration for surgical management include patients with spontaneous pneumothorax with: prolonged air leak, incomplete lung expansion, bilateral pneumothorax, tension pneumothorax or blebs on CT imaging (10). Contraindications to a subxiphoid approach include high BMI, patients with cardiomegaly and reoperative procedures. InstrumentsStandard VATS instruments with dedicated instruments specially designed for SVATS [Shanghai Medical Instruments (Group) Ltd., Shanghai, China] are used during the operations (Figure 1). Surgical procedureA single staged bilateral surgical intervention was planned. The operation was performed with the patient under general anaesthesia and double lumen endotracheal tube intubation to allow for selective lung ventilation. Patient was placed in a left lateral decubitus position slightly rotated posteriorly in order to optimize exposure of the subxiphoid region for the lef...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subxiphoid approach for spontaneous bilateral pneumothorax: a case report

et al. 2017

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“…The camera views and instrument positioning can be more challenging than for conventional VATS but the necessary skills can be acquired over a short learning curve, particularly for minor procedures. The approach has been demonstrated to be safe with good short-term outcomes and superior cosmetic results (7)(8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

Subxiphoid single incision thoracoscopic surgery approach for thymectomy: a case report

et al. 2017

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Thoracic surgery is rapidly evolving with minimally invasive strategies now dominating.Thymectomy has traditionally been performed through a sternotomy, but more recently video-assisted thoracoscopic surgery (VATS) approaches have become increasingly popular. To further minimise surgical impact, the uniportal subxiphoid VATS technique has recently been described, using a muscle sparing incision that avoids intercostal nerve injury. A potential advantage that makes this approach particularly suited to thymectomy includes the ability to access both sides of the chest with a single incision. There is also the potential for reduced post-operative pain and chronic thoracostomy neuralgia. Here we describe the management of a patient with thymoma, reporting our procedure and technique for performing uniportal subxiphoid VATS thymectomy.

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“…Combining these lung-sparing resections with minimally invasive approaches such as uniportal conventional or subxiphoid VATS is feasible and safe (6). Some of the Lower lobe anterior segmentectomy (S8) is not common but lesions that accomplish the aforementioned criteria located in the segment can be attempted.…”

Section: Discussionmentioning

confidence: 99%

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8)

Gálvez¹,

Lirio²,

Sesma³

et al. 2017

J. Vis. Surg.

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Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months. (Figure 2A). Just below the arterial stump, we dissected the bronchus. After initial dissection of both the S8 and the S9+10 segmental bronchus, we individualized the S8 bronchus and, as usual, we made an intraoperative fiberbronchoscopy for guidance and, clamping the segmental bronchus, we checked the bronchoscope light through the bronchial wall proximal to the clamp ( Figure 2B). After careful identification of the segmental vein V8, we divided the fissure between S8 and S9+10 with thick load staplers. Then we checked that the segmental vein V6 and V9+10 were preserved and we divided the V8 by using a vascular stapler ( Figure 2C). Last step to complete the segmentectomy requires division of the parenchyma between S8 and the surrounding segments (S6 and S9+10), and needs a thorough revision for avoiding unnoticed division of V9+10 or V6 with the parenchyma staplers. Total operating time was 140 minutes ( Figure 3).After 24 hours in the Intermediate Care Unit, chest tube was removed without air leak and normal lung reexpansion, and the patient was discharged home on the 5 th postoperative day mainly due to patient's frighten to be discharged sooner after a pulmonary resection. Visual analogue scale (VAS) scores were 3/10 and 3/10 on POD 1 and 2.Final pathological exam showed a 3 cm sclerosant pneumocytoma without mitosis. Chest X-ray one month after the surgery showed an uneventful LLL reexpansion. DiscussionFor many years, anatomical lobectomies and more extensive procedures (bilobectomies and pneumonectomies) were the most common anatomical resections due to better oncologic outcomes for lung cancer surgery (2). Thus, for benign lesions or metastasis, wedge non-anatomical resections were first attempted as they were more simple procedures. Recent advances in the knowledge of lung cancer surgery showed that anatomical segmentectomies have its role in lung cancer treatment because of its comparable outcomes in terms of recurrence and survival, which are si...

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Initial experience in uniportal subxiphoid video-assisted thoracoscopic surgery for major lung resections

Abstract: Uniportal subxiphoid VATS lobectomy/segmentectomy is a feasible and safe procedure for early-stage lung cancer and benign disease.

Cited by 74 publications

References 17 publications

Subxiphoid approach for spontaneous bilateral pneumothorax: a case report

Subxiphoid approach for spontaneous bilateral pneumothorax: a case report

Subxiphoid single incision thoracoscopic surgery approach for thymectomy: a case report

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8)

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