Application of "balance-shaped sternal elevation device" in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Jinlan ¹ , CHEN Weiyang ² , HE Chunmei ¹ , XIONG Yu ¹ , WANG Lei ² , LI Jie ² , LIN Lin ² , YANG Yushang ² , MA Lin ² , CHEN Longqi ² ,  TIAN Dong ²

1. Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

TIAN Dong, Email: 22tiandong@wchscu.cn

Keywords：

Balance-shaped sternal elevation device; anterior mediastinal masses; subxiphoid incision; uniportal video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.202406068

Video：

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Objective To introduce an innovative technique, the "balance-shaped sternal elevation device" and its application in the subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for anterior mediastinal masses resection. Methods Patients who underwent single-port thoracoscopic assisted anterior mediastinal tumor resection through the xiphoid process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from May to June 2024 were included, and their clinical data were analyzed. Results A total of 7 patients were included, with 3 males and 4 females, aged 28-72 years. The diameter of the tumor was 1.9-17.0 cm. The operation time was 62-308 min, intraoperative blood loss was 5-100 mL, postoperative chest drainage tube retention time was 0-9 days, pain score on the 7th day after surgery was 0-2 points, and postoperative hospital stay was 3-12 days. All patients underwent successful and complete resection of the masses and thymus, with favorable postoperative recovery. Conclusion The "balance-shaped sternal elevation device" effectively expands the retrosternal space, providing surgeons with satisfactory surgical views and operating space. This technique significantly enhances the efficacy and safety of minimally invasive surgery for anterior mediastinal masses, reduces trauma and postoperative pain, and accelerates patient recovery, demonstrating important clinical significance and application value.

1.	Nakazono T, Yamaguchi K, Egashira R, et al. Anterior mediastinal lesions: CT and MRI features and differential diagnosis. Jpn J Radiol, 2021, 39(2): 101-117.
2.	Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 332-50.
3.	Predina JD, Keating J, Newton A, et al. A clinical trial of intraoperative near-infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection. Cancer, 2019, 125(5): 807-817.
4.	Gu Z, Fu J, Shen Y, et al. Thymectomy versus tumor resection for early-stage thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis, 2016, 8(4): 680-686.
5.	Yang X, Wang S, Jiang J, et al. Comparison of the perioperative outcomes for thoracoscopic thymectomy between the subxiphoid approach and the lateral intercostal approach for Masaoka-KogaⅠ-Ⅱthymoma: A propensity score-matching analysis. Ann Surg Oncol, 2023, 30(1): 506-514.
6.	Yu L, Zhang XJ, Ma S, et al. Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: A single-center experience. Ann Thorac Surg, 2012, 93(1): 240-244.
7.	Dhamija A, Kakuturu J, Hayanga JWA, et al. Difficult decisions in minimally invasive surgery of the thymus. Cancers (Basel), 2021, 13(23): 5887.
8.	Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg, 1999, 67(1): 263-265.
9.	Suda T. Single-port thymectomy using a subxiphoid approach-surgical technique. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
10.	Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stageⅢ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-S264.
11.	Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
12.	Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
13.	唐焕雨, 黄桁, 姜凯元, 等. 胸腺上皮性肿瘤手术治疗研究进展. 国际肿瘤学杂志, 2020, 47(11): 691-694.Tang HY, Huang H, Jiang KY, et al. Research progress in surgical treatment of thymic epithelial tumors. J Int Oncol, 2020, 47(11): 691-694.
14.	Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score-matched analysis. Int J Surg, 2019, 67: 13-17.
15.	Mas A, Saura P, Joseph D, et al. Effect of acute moderate changes in PaCO₂ on global hemodynamics and gastric perfusion. Crit Care Med, 2000, 28(2): 360-365.
16.	Ren Y, Zhu X, Yan H, et al. Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: A randomized controlled study. BMC Anesthesiol, 2022, 22(1): 76.
17.	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.
18.	张程程, 吴亮, 范江. 治疗重症肌无力的新术式—剑突下双拉钩胸腔镜下胸腺扩大切除术. 中国临床新医学, 2023, 16(6): 547-551.Zhang CC, Wu L, Fan J, et al. A new surgical procedure for the treatment of myasthenia gravis—thoracoscopic extended thymectomy with double retractors subxiphoid. Chin J New Clin Med, 2023, 16(6): 547-551.

1. Nakazono T, Yamaguchi K, Egashira R, et al. Anterior mediastinal lesions: CT and MRI features and differential diagnosis. Jpn J Radiol, 2021, 39(2): 101-117.
2. Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 332-50.
3. Predina JD, Keating J, Newton A, et al. A clinical trial of intraoperative near-infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection. Cancer, 2019, 125(5): 807-817.
4. Gu Z, Fu J, Shen Y, et al. Thymectomy versus tumor resection for early-stage thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis, 2016, 8(4): 680-686.
5. Yang X, Wang S, Jiang J, et al. Comparison of the perioperative outcomes for thoracoscopic thymectomy between the subxiphoid approach and the lateral intercostal approach for Masaoka-KogaⅠ-Ⅱthymoma: A propensity score-matching analysis. Ann Surg Oncol, 2023, 30(1): 506-514.
6. Yu L, Zhang XJ, Ma S, et al. Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: A single-center experience. Ann Thorac Surg, 2012, 93(1): 240-244.
7. Dhamija A, Kakuturu J, Hayanga JWA, et al. Difficult decisions in minimally invasive surgery of the thymus. Cancers (Basel), 2021, 13(23): 5887.
8. Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg, 1999, 67(1): 263-265.
9. Suda T. Single-port thymectomy using a subxiphoid approach-surgical technique. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
10. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stageⅢ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-S264.
11. Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
12. Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
13. 唐焕雨, 黄桁, 姜凯元, 等. 胸腺上皮性肿瘤手术治疗研究进展. 国际肿瘤学杂志, 2020, 47(11): 691-694.Tang HY, Huang H, Jiang KY, et al. Research progress in surgical treatment of thymic epithelial tumors. J Int Oncol, 2020, 47(11): 691-694.
14. Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score-matched analysis. Int J Surg, 2019, 67: 13-17.
15. Mas A, Saura P, Joseph D, et al. Effect of acute moderate changes in PaCO₂ on global hemodynamics and gastric perfusion. Crit Care Med, 2000, 28(2): 360-365.
16. Ren Y, Zhu X, Yan H, et al. Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: A randomized controlled study. BMC Anesthesiol, 2022, 22(1): 76.
17. 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.
18. 张程程, 吴亮, 范江. 治疗重症肌无力的新术式—剑突下双拉钩胸腔镜下胸腺扩大切除术. 中国临床新医学, 2023, 16(6): 547-551.Zhang CC, Wu L, Fan J, et al. A new surgical procedure for the treatment of myasthenia gravis—thoracoscopic extended thymectomy with double retractors subxiphoid. Chin J New Clin Med, 2023, 16(6): 547-551.

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