Single-Incision Subxiphoid Approach for Bilateral Metastasectomy

Suda, Takashi; Ashikari, Shuhei; Tochii, Sachiko; Sugimura, Hiroshi; Hattori, Yoshinobu

doi:10.1016/j.athoracsur.2013.06.123

Cited by 45 publications

(39 citation statements)

References 5 publications

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“…In contrast, intercostal nerve damage is avoided in SPT because of the subxiphoid approach, which is not via the intercostal space. This approach was recently applied to metastasectomy and lobectomy [11,12] and is expected to spread widely as an approach that does not cause intercostal nerve impairment. The length of hospital stay was shorter in the SPT group.…”

Section: Original Articlementioning

confidence: 99%

Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results

Suda

Hachimaru

Tochii

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Compared with conventional median sternotomy, approaches used in thymectomy for myasthenia gravis and anterior mediastinal tumours have become much less invasive in recent years. We previously developed a surgical technique called single-port thymectomy (SPT) to excise the thymus through a single opening made below the xiphoid process. In this study, to show the utility of SPT, we compared factors contributing to low surgical invasiveness between SPT and conventional video-assisted thoracoscopic surgery (VATS) thymectomy. METHODS:Between January 2005 and December 2014, 146 patients underwent surgery for anterior mediastinal tumour or myasthenia gravis at our hospital. After excluding patients diagnosed with tumour invasion of nearby organs or those who had undergone concurrent removal of nearby organs, 81 patients were enrolled in this retrospective study as subjects. Patients were divided into the VATS thymectomy group (VATS group, n = 35) and the SPT group (n = 46). Surgical duration, blood loss, duration of hospital stay and the amount and duration of postoperative oral analgesics were compared between the groups. RESULTS:Operating time did not vary significantly between the VATS and SPT groups (P = 0.0853). The amount of blood loss was higher in the VATS group than in the SPT group (P < 0.0001). The duration of hospital stay was longer in the VATS group than in the SPT group (P = 0.0008). The amount of postoperative oral analgesics was significantly higher in the VATS group than in the SPT group (P = 0.0092). Similarly, the duration of postoperative oral analgesics was significantly longer in the VATS group than in the SPT group (P = 0.0312). CONCLUSIONS:Compared with VATS thymectomy, SPT required a similar operating time, was associated with less blood loss and enabled postoperative analgesics to be discontinued earlier. Therefore, it could be considered a less invasive surgical approach.

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Section: Original Articlementioning

confidence: 99%

Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results

Suda

Hachimaru

Tochii

et al. 2015

Eur J Cardiothorac Surg

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“…It has been employed during the last years for thoracic minor procedures such as thymectomies, pulmonary (11,12). However, this technique was recently introduced for major pulmonary resections in selected patients.…”

Section: Discussionmentioning

confidence: 99%

Subxiphoid uniportal video-assisted thoracoscopic middle lobectomy and anterior anatomic segmentectomy (S3)

González-Rivas¹,

Yang²,

Jiang³

et al. 2016

J. Thorac. Dis.

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The video-assisted thoracoscopic surgery (VATS) approach for combined lobectomy and segmentectomy in the same lung is an infrequent procedure, rarely reported in the literature. Currently, Most of the surgeons still use 2-3 thoracic incisions for thoracoscopic anatomic resections. However, the uniportal approach is gaining worldwide acceptance in the recent years. The main advances of uniportal VATS during the last years are related to improvements in surgical technique by implementing new technology. The experience acquired with the uniportal technique allows expert uniportal VATS surgeons to explore new approaches in order to minimize even more the surgical invasiveness. Recently the aim to avoid the intercostal nerve damage created by the transthoracic incision has led to the creation of a novel procedure entitled uniportal VATS subxiphoid approach. Here we report the first case of a lobectomy combined with anatomic segmentectomy performed through a uniportal subxiphoid approach. (Figure 1). Pulmonary function tests were normal. The patient was proposed for uniportal VATS subxiphoid middle lobectomy and anterior anatomic segmentectomy of the right upper lobe. Surgical technique (Figure 2)The procedure was performed under general anesthesia and double lumen endotracheal intubation. The patient was positioned in lateral position with 60 degrees of inclination. The surgeon and scrub nurse were located in front of the patient and the assistant in the opposite side. A 3-cm midline vertical incision was made below the sterno-costal triangle, (longitudinal incision is made when the infrasternal angle is <70°). The rectus abdominis was divided and the xiphoid process was partially resected in order to have more space for instrumentation. Upon finding the infra-sternal angle between the xiphoid process and the subcostal margin, the right pleura was opened by finger dissection via the infra-sternal angle above the level of the diaphragm. The pericardial fatty tissue was removed and a wound protector was placed. The use of a wound protector helps the insertion of the camera and instruments, without the need of a sternal lifter. A 10-mm, 30-degrees video camera and double articulated instruments combined with several specific longer VATS instruments were used through the same subxiphoid incision. The lung was free of adhesions and a middle lobectomy and anterior anatomic segmentectomy of the right upper lobe (S3) were performed. The mean postoperative time was 70 minutes. A single chest tube was placed at the end of the operation through the subxiphoid incision.Postoperative pain was managed with PCA (Patientcontrolled analgesia) pump as required with sufentanyl citrate 1 mL: 50 mcg and regular medication with flurbiprofen 50 mg every 4 hours alternated with paracetamol 1 gr every 4 hours.The postoperative course of the patient was uneventful, the chest tube was removed on the second postoperative day and the patient was discharged home on the 4 th postoperative day with no complications. The final pathology r...

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“…Suda and colleagues first reported their center's experience with a single subxiphoid incision to perform a thymectomy (15). Following this success they applied the approach to access bilateral pleural spaces to perform pulmonary metastasectomy (16). Closely following this report, Liu and colleagues reported their experience with uniportal subxiphoid VATS lung resections, particularly uniportal subxiphoid lobectomy (17).…”

Section: Widespread Applicationmentioning

confidence: 99%