Uniportal versus three-port subxiphoid video-assisted thoracoscopic extended thymectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Dong , ZHANG Miao , YANG Dunpeng ,  PAN Xuefeng , WU Wenbin

Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P.R.China;

Corresponding author：

PAN Xuefeng, Email: panxf2015@163.com

Keywords：

Subxiphoid; uniportal; video-assisted thoracoscopic surgery; extended thymectomy

DOI：

10.7507/1007-4848.201905051

Video：

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Objective To investigate the clinical characteristics of uniportal and three-port subxiphoid video-assisted thoracoscopic surgery (XVATS) extended thymectomy.Methods The clinical data of 60 consecutive patients of XVATS thymectomy in Xuzhou Central Hospital from January 2017 to May 2019 were retrospectively analyzed. There were 29 males and 31 females, with an average age of 53.1 (27.0-76.0) years. The patients were divided into an uniportal XVATS group (30 patients) and a three-port XVATS group (30 patients). The clinical effectiveness was compared between the two groups.Results There was no significant difference in age, sex, body mass index, tumor size, intraoperative blood loss, postoperative time of thoracic tube indwelling and thoracic drainage, or postoperative hospitalization time between the two groups (P>0.05). There was no perioperative mortality, conversion to thoracotomy, thrombosis or mediastinal infection. The operation time of the uniportal XVATS group was significantly longer than that of the three-port group (87.5±19.0 min vs. 75.8±15.7 min, P=0.012). Besides, patients in the uniportal group had significantly lower pain score during 3-14 postoperative days than that of the three-port group (P=0.001).Conclusion Uniportal XVATS extended thymectomy is feasible with less pain as compared with the patients using three-port XVATS, but it needs longer operation time at initial stage.

Citation： LIU Dong, ZHANG Miao, YANG Dunpeng, PAN Xuefeng, WU Wenbin. Uniportal versus three-port subxiphoid video-assisted thoracoscopic extended thymectomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 539-543. doi: 10.7507/1007-4848.201905051 Copy

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2.	孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
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10.	江贤亮, 徐美清, 马冬春, 等. 胸腔镜手术治疗纵隔肿瘤 137 例临床分析. 中华解剖与临床杂志, 2016, 21(2): 165-167.
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12.	Chiu CH, Chao YK, Liu YH. Subxiphoid approach for video-assisted thoracoscopic surgery: an update. J Thorac Dis, 2018, 10(Suppl 14): S1662-S1665.
13.	Abdellateef A, Ali JM, Jiang G, et al. Tips and tricks for success in subxiphoid video-assisted thoracic surgery. J Thorac Dis, 2019, 11(1): 292-301.
14.	徐朋亮, 陈刚, 朱勇俊, 等. 胸腔镜胸腺切除术剑突下入路与侧胸入路的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(9): 799-803.
15.	Mineo TC, Ambrogi V. Surgical techniques for myasthenia gravis: video-assisted thoracic surgery. Thorac Surg Clin, 2019, 29(2): 165-175.
16.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
17.	Suda T. Robotic subxiphoid thymectomy. J Vis Surg, 2016, 2: 118.
18.	Batirel HF. Minimally invasive techniques in thymic surgery: a worldwide perspective. J Vis Surg, 2018, 4: 7.
19.	张含露, 刘伦旭, 陈龙奇, 等. 机器人辅助经剑突下胸腺(扩大)切除手术的临床应用. 中国胸心血管外科临床杂志, 2017, 24(10): 743-747.
20.	Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.
21.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
22.	Gkouma A. Robotically assisted thymectomy: a review of the literature. J Robot Surg, 2018, 12(1): 3-10.

1. Aramini B, Fan J. Technique for myasthenia gravis: subxiphoid approach. Thorac Surg Clin, 2019, 29(2): 195-202.
2. 孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
3. Shiomi K, Kitamura E, Ono M, et al. Feasible and promising modified trans-subxiphoid thoracoscopic extended thymectomy for patients with myasthenia gravis. J Thorac Dis, 2018, 10(3): 1747-1752.
4. Suda T. Single-port thymectomy using a subxiphoid approach-surgical technique. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
5. 谷志涛, 方文涛. 胸腺肿瘤微创切除手术的基本原则与质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 29-34.
6. Orsini B, Santelmo N, Pages PB, et al. Comparative study for surgical management of thymectomy for non-thymomatous myasthenia gravis from the French national database EPITHOR. Eur J Cardiothorac Surg, 2016, 50(3): 418-422.
7. Ponseti JM, Gamez J, Vilallonga R, et al. Influence of ectopic thymic tissue on clinical outcome following extended thymectomy in generalized seropositive nonthymomatous myasthenia gravis. Eur J Cardiothorac Surg, 2008, 34(5): 1062-1067.
8. 方文涛, 傅剑华, 沈毅, 等. 胸腺肿瘤的诊疗: 基于中国胸腺肿瘤协作组多中心回顾性研究的共识. 中国肺癌杂志, 2016, 19(7): 414-417.
9. Zieliński M. Surgical approaches to myasthenia gravis: perspective of anatomy and radicality in surgery. Thorac Surg Clin, 2019, 29(2): 159-164.
10. 江贤亮, 徐美清, 马冬春, 等. 胸腔镜手术治疗纵隔肿瘤 137 例临床分析. 中华解剖与临床杂志, 2016, 21(2): 165-167.
11. 唐桂旺, 叶敬霆, 武强, 等. 不同种手术方式治疗胸腺瘤合并重症肌无力的比较. 中国胸心血管外科临床杂志, 2018, 25(9): 767-771.
12. Chiu CH, Chao YK, Liu YH. Subxiphoid approach for video-assisted thoracoscopic surgery: an update. J Thorac Dis, 2018, 10(Suppl 14): S1662-S1665.
13. Abdellateef A, Ali JM, Jiang G, et al. Tips and tricks for success in subxiphoid video-assisted thoracic surgery. J Thorac Dis, 2019, 11(1): 292-301.
14. 徐朋亮, 陈刚, 朱勇俊, 等. 胸腔镜胸腺切除术剑突下入路与侧胸入路的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(9): 799-803.
15. Mineo TC, Ambrogi V. Surgical techniques for myasthenia gravis: video-assisted thoracic surgery. Thorac Surg Clin, 2019, 29(2): 165-175.
16. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
17. Suda T. Robotic subxiphoid thymectomy. J Vis Surg, 2016, 2: 118.
18. Batirel HF. Minimally invasive techniques in thymic surgery: a worldwide perspective. J Vis Surg, 2018, 4: 7.
19. 张含露, 刘伦旭, 陈龙奇, 等. 机器人辅助经剑突下胸腺(扩大)切除手术的临床应用. 中国胸心血管外科临床杂志, 2017, 24(10): 743-747.
20. Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.
21. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
22. Gkouma A. Robotically assisted thymectomy: a review of the literature. J Robot Surg, 2018, 12(1): 3-10.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Uniportal versus three-port subxiphoid video-assisted thoracoscopic extended thymectomy: A retrospective cohort study

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