A preliminary application analysis of the subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor

doi:10.3877/cma.j.issn.2095-8773.2019.03.03

Abstract

Abstract:

Objective

To evaluate the clinical value of subxiphoid approach in videoassistedthoracoscopicresection of anterior mediastinal tumor .

Methods

From January 2016 to June 2019 ,23 patients with anterior mediastinal tumor all underwent thoracoscopic tumorresection surgeries ,among which 18 patients received unilateral thoracoscopic surgery (control group) and 5 patients received subxiphoidthoracoscopic surgery ( research group) .

Results

All the patients in the two groups successfully completed the operation according to their predetermined method .One case in the research group suffered mediastinal tumorsencroaching on the left upperlung , and wedge resection of the left upper lung was performed at the same time .There was no significant difference in intraoperative blood loss ,length of hospital stay , and drainage tube indwelling time between the two groups ( P＞0 .05) ,however ,there were significant differences in operative time ( P＜0 .05) ,and postoperative pain score at 24 h ( P＜0 .05) .None of the patients underwent postoperative bleeding and secondary thoracotomy ,and one patient in the control group got postoperative left eyelid droop , whichimproved after follow-up .

Conclusions

The subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor is safe ,feasible and has obvious advantages and shall be popularized .

Key words: Subxiphoid, Anterior mediastinal tumors, Video-assisted thoracic surgery

Qiuhua Yu, Mingyan Jiang, Yajun Lv, Jun Huang, Xiaobo Zhu, Feng Jiang, Qiang Wang. A preliminary application analysis of the subxiphoid approach in video-assistedthoracoscopicresection of anterior mediastinal tumor[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(03): 152-155.

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URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2019.03.03

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2019/V06/I03/152

Figures/Tables 2

References 19

1	Kondo K , Monden Y . Therapy for thymic epithelial tumors : a clinical study of 1 ,320 patients from Japan[J] . Ann Thorac Surg ,2003 ,76(3) :878-884 .
2	Chen H , Xu G , Zheng W , et al . Video-assisted thoracoscopic extended thymectomy using the subxiphoid approach[J] . J Vis Surg ,2016 ,2 :157 .
3	Suda T , Hachimaru A , Tochii D , et al . Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy :initial resultsdagger[J] .Eur J Cardiothorac Surg ,2016 ,49 (Suppl 1) :i54-i58 .
4	Zielinski M , Czajkowski W , Gwozdz P , et al . Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum[J] . Eur J Cardiothorac Surg ,2013 ,44(2) :e113-119 .
5	Yano M , Moriyama S , Haneda H , et al . The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach[J] . World J Surg ,2017 ,41(3) :763-770 .
6	Suda T . Subxiphoid thymectomy : single-port , dual-port , and robot-assisted[J] . J Vis Surg , 2017 ,3 :75 .
7	Chiu CH , Chao YK , Liu Y H . Subxiphoid approach for videoassisted thoracoscopic surgery : an update[J] . J T horac Dis ,2018 ,10(Suppl 14) :S1662-S1665 .
8	Numanami H , Yano M , Yamaji M , et al . T horacoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors[J] . Ann Thorac Cardiovasc Surg ,2018 ,24(2) :65-72 .
9	Suda T , Kaneda S , Hachimaru A , et al . T hymectomy via a subxiphoid approach : single-port and robot-assisted [ J ] . J T horac Dis ,2016 ,8(Suppl 3) :S265-271 .
10	Luo T , Zhao H , Zhou X . The clinical features , diagnosis and management of recurrent thymoma[J] . J Cardiothorac Surg ,2016 ,11(1) :140 .
11	Suda T ,Sugimura H , Tochii D ,et al .Single-port thymectomy through an infrasternal approach[J] . Ann Thorac Surg ,2012 ,93(1) :334-336 .
12	Hsu CP ,Chuang CY , Hsu NY ,et al .Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extendedthymectomyfor myasthenia gravis[J] .Surg Endosc ,2004 ,18(5) :821-824 .
13	Suda T , Ashikari S , Tochii D , et al . Dual-port thymectomy using subxiphoid approach[J] . Gen Thorac Cardiovasc Surg ,2014 ,62(9) :570-572 .
14	付金松，杨刚，郑献身，等.剑突下单孔胸腔镜肺大疱手术疗效随机对照研究［J] .临床肺科杂志，2018 ，23（12）：2234-2238 .
15	Abu-Akar F , Gonzalez-Rivas D , Yang C , et al . Subxiphoid uniportal VA TS for thymic and combined mediastinal and pulmonary resections - atwo-year experience[J] . Semin Thorac Cardiovasc Surg ,2019 ,31(3) :614-619 .
16	Martinez-Tellez E , Trujillo-Reyes JC , Guarino M , et al .Subxiphoid video-thoracoscopy [ J] . J T horac Dis , 2018 ,10(Suppl 22) :S2643-S2648 .
17	Suda T , Tochii D , Tochii S , et al . Trans-subxiphoid robotic thymectomy[J] .Interact Cardiovasc Thorac Surg ,2015 ,20(5) :669-671 .
18	Zhang H ,Chen L ,Zheng Y ,et al .Robot-assisted thymectomy via subxiphoid approach : technical details and early outcomes[J] .J Thorac Dis ,2018 ,10(3) :1677-1682 .
19	郭少鸣，蒋家好，金淳，等.改良剑突下入路胸腔镜前纵隔畸胎瘤切除术的临床应用分析［J] .中国临床医学，2019 ，26（1）：43-45 .

组别	例数	手术时间（min）	术中出血量（ml）	住院时间（d）	术后24h疼痛评分	术后引流管留置时间（d）
对照组	18	81.2±33.7	102.8±95.4	6.3±1.2	2.7±0.5	3.7±1.1
研究组	5	117.0±31.4	116.0±113.1	6.2±0.8	1.8±0.5	3.4±0.6
ｔ值		2.126	0.264	0.137	3.586	0.640
Ｐ值		＜0.05	＞0.05	＞0.05	＜0.05	＞0.05

组别	例数	手术时间（min）	术中出血量（ml）	住院时间（d）	术后24h疼痛评分	术后引流管留置时间（d）
对照组	18	81.2±33.7	102.8±95.4	6.3±1.2	2.7±0.5	3.7±1.1
研究组	5	117.0±31.4	116.0±113.1	6.2±0.8	1.8±0.5	3.4±0.6
ｔ值		2.126	0.264	0.137	3.586	0.640
Ｐ值		＜0.05	＞0.05	＞0.05	＜0.05	＞0.05

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[2]	Qinlang Shi, Pilai Huang, Shuo Zheng, Qiang Fu, Yanfeng Wang, Danying Yin, Sisi Wang, Ning Xiang, Kun Qiao. Exploration and practice of day surgery and enhanced recovery after surgery for thoracic sympathectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(04): 233-237.
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[4]	Jiajun Chen, Wentian Zhang, Kun Chen, Jichen Qu, Yuming Zhu, Lei Jiang. Nonintubated uniportal subxiphoid video-assisted thoracoscopic right pneumonectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(02): 117-119.
[5]	Juntang Guo, Bin Wang, Leilei Shen, Chaoyang Liang, Yang Liu. Comparative analysis of clinical outcomes of video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid and lateral intercostal approaches [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 221-225.
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[8]	Miao Zhang, Wenbin Wu, Dunpeng Yang, Dong Liu, Hui Zhang, Zhengqun Hu. A clinical analysis on subxiphoid and intercostal video-assisted thoracoscopic extended thymectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2019, 12(03): 166-170.
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[11]	Zhijun Zhu, Jinlong Wu, Da Ni, Jiping Teng, Xiang Liang, Haoran Ji, Hao Li, Xin Guan, Zhiyin Yang, Mingsong Wang. Sternal traction hook-assisted subxiphoid single-hole process for anterior mediastinal tumor surgery [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(01): 22-28.
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[14]	Miao Zhang, Wenbin Wu, Dunpeng Yang, Hui Zhang, Zhengqun Hu, Dong Liu, Min Li. An analysis on learning curve of subxiphoid uniportal video-assisted thoracoscopic extended thymectomy [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(03): 146-151.
[15]	Tian Zhao, Miao Zhang, Wenbin Wu, Dong Liu, Xuefeng Pan, Cunjiang Li, Hui Zhang, Zhengqun Hu, Dunpeng Yang, Min Li. Clinical analysis on single-direction uniportal thoracoscopic lobectomy [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(03): 173-179.

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