Subxiphoid pneumonectomy: the new frontier?

Ali, Jason M.; Kaul, Pratibha; Jiang, Lei; Yang, Chenlu; Chen, Jian; Zhang, Yunsong; Zhang, Zhigong; Aresu, Giuseppe

doi:10.21037/jtd.2018.06.139

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Uniportal SVATS was initially utilized for non-anatomical lung resections and thymectomy (8,9). However, with experience, the entire range of thoracic surgical procedures have been reported to be performed through SVATS (10)(11)(12)(13)(14)(15)(16)(17). We have previously reported data suggesting that SVATS may be associated with reduced post-operative pain following lobectomy compared with uniportal VATS (18).…”

Section: Original Articlementioning

confidence: 99%

Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy

Chen¹,

Volpi²,

Ali³

et al. 2020

J Thorac Dis

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Background: Uniportal video-assisted thoracoscopic surgery (VATS) although considered less invasive than the multi-port techniques, is still an intercostal approach, resulting in intercostal nerve injury. Recently, some surgeons have tried to address this problem by attempting a subxiphoid approach. The aim of our study was to assess and compare results between intercostal and subxiphoid uniportal VATS lobectomy in terms of postoperative pain and quality of life (QoL). Methods: Patients from January 2014 to January 2018 undergoing subxiphoid and intercostal VATS lobectomy were prospectively assessed for pain and QoL at 1, 3, and 6 months following discharge.Postoperative pain was measured using a numeric rating scale (NRS) and QoL was assessed with the EuroQoL 5-dimension questionnaire (EQ5D) Results: Eight hundred and thirty-three patients undergoing lobectomy were included: 373 in the intercostal VATS group and 459 in the subxiphoid group. The proportion of patients with moderate or worse clinical pain was significantly lower at 1 and 3 months after subxiphoid VATS (P<0.01) compared with intercostal VATS. QoL was significantly higher following subxiphoid VATS at these same time points (P<0.001). Conclusions: Uniportal subxiphoid VATS is a safe and feasible minimally invasive approach for undertaking pulmonary lobectomy that may result in reduced postoperative pain compared to conventional VATS. There may also be earlier return of QoL. A randomized controlled trial examining this further would provide further insight into our observations.

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Section: Original Articlementioning

confidence: 99%

Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy

Chen¹,

Volpi²,

Ali³

et al. 2020

J Thorac Dis

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“…The challenges around a spontaneously ventilating technique in pneumonectomy include minimizing mediastinal movement during surgery and maintaining permissible levels of hypercarbia without negatively affecting physiology. [6][7][8] By minimizing side effects such as postoperative nausea and vomiting, opioid-induced ventilatory impairment, and delirium, opioid-free anesthesia can promote earlier return to baseline function in post-thoracic surgical patients, who often have preexisting comorbidities and frailty.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Subxiphoid, Nonintubated, Opioid-Free, Video-Assisted Pneumonectomy: A New Frontier in Thoracic Surgery

Nizami

Hogan

Ali

et al. 2021

Innovations�(Phila)

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Surgical approaches to major pulmonary resections have evolved from thoracotomy to multiportal video-assisted thoracoscopy (VATS) and subsequently uniportal VATS. The efficacy of this progress has been validated in a multitude of publications demonstrating reductions in complications, patient perception of pain, and postoperative length of stay. More recent advances include subxiphoid extrathoracic access and nonintubated, opioid-free anesthesia. Early publications have demonstrated promising results with respect to safety, technical feasibility, and enhanced recovery. However, there remains a paucity of literature relating to hybrid approaches comprising both subxiphoid and nonintubated, opioid-free anesthesia in the context of pneumonectomy. The current report is the case of a patient undergoing pneumonectomy. Both subxiphoid and nonintubated, opioid-free techniques were utilized. The authors describe preoperative workup, surgical and anesthesia-related caveats, and postoperative recovery. In conclusion, this approach is technically feasible, safe, and may be associated with enhanced recovery.

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“…They observed a significant reduction on postoperative pain in the SVATs group which was associated with earlier mobilisation and reduced risk of complication (5). The SVATS approach has become increasingly popular, and there are reports of a wide range of operations being performed from anatomical segmentectomies to pneumonectomies (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Anaesthesia and Enhanced Recovery In Subxiphoid Video-assistmentioning

confidence: 98%

Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

Chen

Ali

et al. 2018

J. Thorac. Dis

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Subxiphoid video-assisted thoracoscopic surgery (VATS) is a surgical approach in minimally invasive thoracic surgery that aims to aid enhanced recovery by reducing postoperative pain by avoiding instrumentation of the intercostal spaces. Access through a subxiphoid port presents challenges for both the surgeon and anaesthetist. Particularly for left sided procedures, the heart can be compressed resulting in arrhythmia and haemodynamic compromise. The anaesthetic team play an important role in ensuring the success of subxiphoid VATS procedures. The key is continuous and comprehensive monitoring for circulatory disturbance and arrhythmia intraoperatively. Should arrhythmia develop it is important that it is managed rapidly and effectively in such a manner to minimize haemodynamic disturbance. In this article, important considerations for anaesthesia in subxiphoid VATS procedures is presented and solutions presented.

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Subxiphoid pneumonectomy: the new frontier?

Cited by 5 publications

References 32 publications

Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy

Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy

Subxiphoid, Nonintubated, Opioid-Free, Video-Assisted Pneumonectomy: A New Frontier in Thoracic Surgery

Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

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