Bilateral Lung Resection Via Subxiphoid Uniportal Vats: A Report Of 46 Cases
Haomin Cai, Deping Zhao, Lei Jiang, Chang Chen, Gening Jiang.
Shanghai Pulmonary Hospital, Shanghai, China.
Background: Since the first lobectomy via subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) in mainland China was carried out in Shanghai Pulmonary Hospital in 2014, more than a thousand cases of various surgeries via subxiphoid uniportal VATS have been performed to date. As both sides of the thoracic cavity can be accessed to through one single subxiphoid incision, the technique is obviously superior to the intercostal uniportal approach in treating bilateral pulmonary lesions. This paper is intended as a brief report of the cases that underwent bilateral lung resection via subxiphoid uniportal VATS in our institution.
Methods: The clinical data of 46 cases who had undergone bilateral lung resection via subxiphoid uniportal VATS in Shanghai Pulmonary Hospital from September 2014 to July 2017 were retrospectively analyzed. Among them, there were 20 males and 26 females, with an average age of 55.2 years old. Except six patients who underwent bilateral bullae resection, the remaining 40 ones underwent various types of lung resections due to bilateral pulmonary nodules. Specifically, there were three cases of bilateral lobectomy, eight cases of unilateral lobectomy plus unilateral segmentectomy, fourteen cases of unilateral lobectomy plus unilateral wedge resection, two cases of bilateral segmentectomy, five cases of unilateral segmentectomy plus unilateral wedge resection, and eight cases of bilateral wedge resection.
Results: The average operation duration was 192.8 min, the mean blood loss was 111.5 ml, and no intraoperative blood loss was more than 500 ml. Three cases were added with intercostal operation holes during surgery, all of which were on the left side, due to too large size of heart for an adequate surgical exposure or unsuccessful nodule exploration. The average length of postoperative hospital stay was 6.0 days. A patient who had undergone right upper and left lower lobectomy suffered persistent pulmonary infections and respiratory failure after surgery, complicated with cerebral infarction. The patient was died 25 days after surgery. A patient received further operation due to continuous bleeding around the incision on the first day after surgery. A patient undergoing bilateral lower lobectomy and another undergoing bilateral wedge resection for bilateral bullae were given mechanical ventilation support due to postoperative pulmonary infections and were discharged 41 days and nine days after surgery, respectively. The rest of the patients recovered well after surgery.
Conclusions: Subxiphoid uniportal VATS can be widely used in various types of bilateral lung resections. It is conducive to minimize aesthetically undesirable incision and postoperative pain in patients, especially for the resections of bilateral bullae or metastases. Surgical exposure on the left side might be poor due to the presence of the heart. For pulmonary nodules located on the dorsal surface, subxiphoid uniportal wedge resection is not recommended. Bilateral lobectomy should be carried out with discretion.
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