Single-port Video Assisted Thoracoscopic Thymectomy Through Subxiphoidal Incision Without Co2 Insufflation
Do Kyun Kang, Ji Yong Kim, Ho-ki Min, Youn-Ho Hwang, Hee Jae Jun.
Haeundae Paik Hospital, Busan, Korea, Republic of.
OBJECTIVE: Single-port VATS thymectomy through sub-xiphoidal incision was introduced by some authors. They reported that CO2 insufflation to the mediastinum was needed for securing the retrosternal space with an air-tight trocar sleeve. It is useful, however sometimes it causes hypotension due to extrinsic compression of the heart and cannot provide optimal space for the surgery. We present our experiences of single-port VATS thymectomy through sub-xiphoidal incision using a wire and Kent retractor under the one-lung ventilation without CO2 insufflation.
METHODS: Single-port VATS thymectomy through sub-xiphoidal incision was attempted in 18 patients from August 2014 to Decepber 2016. Sixteen patients underwent the surgery as planned. Surgical procedure performed in the supine position and under the general anesthesia using a double lumen endotracheal tube. A sub-xiphoidal incision (about 4cm) was made on the xiphoid process. The xiphoid process was resected. After blunt dissection of the retrosternal space, an X-small sized wound retractor was applied. The wire was passed the retrosternal space through the bilateral 4th intercostal space and lifted up using Kent retractor for securing the retrosternal space. After examining the bilateral phrenic nerves, thymectomy was performed with an ultrasonic scalpel and 5mm-30degree thoracoscope.
RESULTS: The thymectomy was performed in 13 patients with thymoma, thymic cyst, hamartoma or mesothelial cyst. The extended thymectomy was performed in 3 patients with thymic hyperplasia and myasthenia gravis. Single-port VATS was converted into sternotomy or bilateral VATS thymectomy in two patients because of injury of the internal mammary artery and technical difficulties. The mean operation time was 134 minutes (range: 85-210). The mean duration of the chest tube drainage was 2.7 days. The mean duration of the hospital stay was 5.4 days. There was no surgical mortality and complication.
CONCLUSIONS: In our experiences, single-port VATS thymectomy through sub-xiphoidal incision using a wire and Kent retractor under one-lung ventilation without CO2 insufflation was feasible.
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