Uniportal Subxiphoid Video-Assisted Thoracoscopic Anatomical Segmentectomy: Technique and Results

Abstract

This report demonstrates that the uniportal SVATS approach can be safely and effectively utilized to perform pulmonary segmentectomies. Our series demonstrates that it is possible to access and resect all segments by this novel approach to VATS.

Subxiphoid uniportal thoracoscopic pulmonary segmentectomy for stage I non‐small cell lung cancer: Feasibility, quality of life and financial worthiness

“…One patient in the subxiphoid group experienced intraoperative ventricular fibrillation which necessitated urgent thoracotomy for resuscitation and cardiac message after a failed trial of direct current cardioversion (DCCV), but the situation was managed safely without any postoperative sequelae. Therefore, one of the precautions in preoperative case selection in SVATS is to avoid patients with a history of cardiac disease or arrhythmia, in particular those with left‐sided lesions . Backward tilting of the patient during positioning and use of longer and specially curved instruments with the concave edge of the instruments toward the pericardium during the operation have enabled surgeons to make better retraction with consequent lower compression on the heart …”

“…Also, one of our selection criteria during our initial subxiphoid experience was to avoid operating on patients with posterior lesions . However, with increasing experience and use of the specially designed long curved instruments, more challenging cases of posterior segmentectomies could be managed …”

“…The pleura of the operated side was then opened under thoracoscopic visualization and the pericardiophrenic fat was removed. Detailed surgical procedures of both approaches together with the intersegmental plan identification have been previously described in different publications …”

“…Subxiphoid uniportal video‐assisted thoracoscopic surgery (SVATS) has been introduced as safe and feasible alternative approach for intercostal uniportal video‐assisted thoracoscopic surgery (UVATS) in various thoracic surgical procedures . Despite more technical difficulties than UVATS, many surgeons are still eager to perform SVATS due to the advantages of being associated with lower postoperative pain and the ability to perform bilateral lesions and concomitant mediastinal and pulmonary lesions through a single incision .…”

Innovative Method of Pericardial Fenestration Associated With Underlying Chronic Recurrent Pericarditis: Case Report

“…Одним из таких подходов стало выполнение торакоскопии через субксифоидальный доступ. Сторонники подобного подхода аргументируют свой приоритет в первую очередь минимизацией количества разрезов, а также клинически значимым меньшим послеоперационным болевым синдромом, чем после торакоскопии, проведенной через доступы в межреберьях [6,7,8]. Фенестрация перикарда, выполняемая при перикардитах различной этиологии с угрозой тампонады сердца, традиционно осуществляется посредством двух основных видов доступа -субксифоидальным с формированием перикардио-перитонеального соустья или трансторакальным с формированием перикардио-плеврального окна [9,10,11].…”