Mao Teng, Zhang Xuefei, Yang Yu, Xu Ning, Fang Wentao
Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Thorac Dis. 2023 Mar 31;15(3):1364-1372. doi: 10.21037/jtd-23-244.
Minimally invasive surgery has been used to treat anterior mediastinal tumors. This study sought to describe a single team's experience of uniport subxiphoid mediastinal surgery using a modified sternum retractor.
Patients who underwent uniport subxiphoid video-assisted thoracoscopic surgery (USVATS) or unilateral video-assisted thoracoscopic surgery (LVATS) from September 2018 to December 2021 were retrospectively enrolled in this study. A 5-cm vertical incision approximately 1-cm caudal to the xiphoid process was usually made followed by the installment of a modified retractor, which was able to raise the sternum by 6-8 cm. Next, the USVATS was performed. In the unilateral group, 3 1-cm incisions were usually made, among which, 2 are made in the 2 or 3 and 5 intercostal anterior axillary line, and the 3 was made in the 5 intercostal midclavicular line. In some instances, an additional subxiphoid incision was made to remove the large tumors. All the clinical and perioperative data, including the prospectively recorded visual analogue scale (VAS) score, were analyzed.
In total, 16 patients who underwent USVATS and 28 patients who underwent LVATS were enrolled in this study. With the exception of tumor size (USVATS 7.9±1.6 cm LVATS 5.1±2.4 cm, P<0.001), the baseline data of the patients in the 2 groups were comparative. Blood loss in surgery, conversion, draining duration, postoperative stay, postoperative complications, pathology and tumor invasion were similar between the 2 groups. Although the operation time was significantly longer in the USVATS group than the LVATS group (115±19 83±30 min, P<0.001), the VAS score at 1st postoperative day (1.9±1.1 3.1±1.1, P<0.001) and moderate pain level (a VAS score >3) (6.3% 32.1%, P=0.049) were better in the USVATS group than the LVATS group.
Uniport subxiphoid mediastinal surgery is a feasible and safe procedure, especially for large tumors. Our modified sternum retractor is especially helpful during uniport subxiphoid surgery. Compared to lateral thoracic surgery, this approach has the advantages of less injury and lower postoperative pain, which may lead to a faster recovery. However, its long-term follow-up outcomes need to be observed.
微创手术已被用于治疗前纵隔肿瘤。本研究旨在描述一个团队使用改良胸骨牵开器进行单孔剑突下纵隔手术的经验。
回顾性纳入2018年9月至2021年12月期间接受单孔剑突下电视辅助胸腔镜手术（USVATS）或单侧电视辅助胸腔镜手术（LVATS）的患者。通常在剑突下约1cm处做一个5cm的垂直切口，然后安装改良牵开器，该牵开器能够将胸骨抬高6-8cm。接下来进行USVATS。在单侧组中，通常做3个1cm的切口，其中2个在腋前线第2或3肋间和第5肋间，第3个在锁骨中线第5肋间。在某些情况下，会额外做一个剑突下切口以切除大肿瘤。分析所有临床和围手术期数据，包括前瞻性记录的视觉模拟量表（VAS）评分。
本研究共纳入16例行USVATS的患者和28例行LVATS的患者。除肿瘤大小外（USVATS组7.9±1.6cm，LVATS组5.1±2.4cm，P<0.001），两组患者的基线数据具有可比性。两组在手术出血量、中转率、引流时间、术后住院时间、术后并发症、病理及肿瘤侵犯情况方面相似。虽然USVATS组的手术时间明显长于LVATS组（115±19比83±30分钟），P<0.001），但USVATS组术后第1天的VAS评分（1.9±1.1比3.1±1.1，P<0.001）和中度疼痛水平（VAS评分>3）（6.3%比32.1%，P=0.049）均优于LVATS组。
单孔剑突下纵隔手术是一种可行且安全的手术方法，尤其适用于大肿瘤。我们的改良胸骨牵开器在单孔剑突下手术中特别有用。与侧胸手术相比，这种方法具有损伤小、术后疼痛轻的优点，可能导致恢复更快。然而，其长期随访结果有待观察。
