A proof-of-concept study: advantages of the subxiphoid over the lateral intercostal approach

Abstract

OBJECTIVES The study was designed to evaluate the superiority of the subxiphoid approach comparing with the lateral intercostal approach during the process of operation, and other perioperative indices. METHODS Patients diagnosed anterior mediastinal disease in our hospital between January 2018 and October 2019 were prospectively assigned into two groups, receiving the lateral intercostal approach or the subxiphoid approach VATS to resect the disease. The PaCO2, SaO2, PaO2 and circulation changes were recorded during the operation, neutrophil-to-lymphocyte ratio, and other perioperative outcomes, including clinical and surgical results, operation time, blood loss, postoperative complication, postoperative pain score were compared. RESULTS A total 59 patients diagnosed anterior mediastinal tumour or myasthenia gravis underwent the resection by VATS. 31 patients were treated with the subxiphoid approach, 28 patients were treated with the lateral intercostal approach. PaCO2 increased significantly and SaO2 remained stable in the subxiphoid group during the operation, while PaCO2 increased significantly and SaO2 decreased at the same time in the lateral intercostal group. Operations were more frequently interrupted for the hypoxia or circulation disturbance during the process of dissecting the thymus in the lateral intercostal approach. Compared with the lateral intercostal approach, patients in the subxiphoid approach experienced less inflammation reaction, and yielded lower pain score and shorter postoperative hospital stay. There were no significant differences in postoperative complications between the two groups. All these patients recovered well when discharged. CONCLUSIONS Our study suggested that subxiphoid approach will influence pulmonary and circulation lesser than the lateral intercostal approach, and the whole procedure will be safer and easier, and the subxiphoid approach may be the ideal choice for the anterior mediastinal disease.