Subxiphoid complex uniportal video-assisted major pulmonary resections

Abstract

In recent years, the search for a less invasive and thus, less painful approach has driven technical innovation in modern thoracic surgery. In this context, subxiphoid uniportal approach has emerged as an alternative to avoid intercostal space manipulation and decrease postoperative pain and intercostal nerve chronic impairment. Subxiphoid uniportal major lung resections have been safe and effective procedures when performed by experienced surgeons even in complex cases or unexpected intraoperative situations. We present six of these surgical scenarios such as big tumors, incomplete or absent fissures, hilar calcified lymph nodes, active bleeding and massive adhesions to show the feasibility of subxiphoid approach to manage even these conditions.

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

“…Intraoperative cardiac arrhythmia is known to occur during SVATS, especially in patients with left‐sided basal lesions due to a greater incidence of cardiac compression . 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.…”

Subxiphoid pneumonectomy: the new frontier?

“…In the case of standard VATS, there are reports of requiring rib spreading and the lung being retrieved in pieces. Furthermore, retrieval may result in compression of the intercostal nerves which can result in chest wall pain which may be chronic in some patients More recently, the subxiphoid uniportal VATS technique has been described, avoiding any intercostal incision or instrumentation (14)(15)(16)(17)(18)(19)(20)(21)28,29). Additionally, since the chest drains are not entering the thoracic cavity through intercostal spaces postoperatively, they do not impinge on the intercostal neurovascular bundle during mobilization of the patient.…”

“…More recently, the subxiphoid-VATS approach has been described and is increasingly utilised for a range of thoracic operations including thymectomy, lobectomy, segmentectomies and resection of giant solitary fibrous tumours of the pleura (14)(15)(16)(17)(18)(19)(20)(21). In this technique, a single vertical muscle-sparing incision is made in the subxiphoid space permitting thoracic surgery to be performed without requiring intercostal incisions.…”

Enhanced recovery pathways in thoracic surgery: the Shanghai experience

“…In recent years, the most advanced minimally invasive techniques have been adopted by most of the surgeons in our academy. More than 90% of the operations are performed by the VATS and most (even complex ones) are performed by intercostal, subxiphoid and subcostal uniportal VATS approaches (18)(19)(20). In addition to excellent results, these techniques have helped us to shorten the time and effort in pain management during and after the operation.…”