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Ann Thorac Surg 2007;83:1978-1984
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Transxiphoid Hand-Assisted Videothoracoscopic Surgery

Thoracic Surgery Division, Policlinico Tor Vergata University, Rome, Italy

Accepted for publication February 7, 2007.

^_* Address correspondence to Dr Mineo, Cattedra di Chirurgia Toracica, Policlinico Tor Vergata, Viale Oxford 81, Rome, 00133, Italy (Email: mineo{at}med.uniroma2.it).

Background: We have performed transxiphoid hand-assisted videothoracoscopy since 1995 to allow manual palpation in bilateral lung metastasectomy. This approach was extended to other thoracoscopic procedures requiring a handport. No extensive report about early and late results has yet been published.

Methods: We retrospectively reviewed the first 100 consecutive patients undergoing transxiphoid hand-assisted videothoracoscopy. Acute and chronic postoperative pain, respiratory function, patient’s satisfaction score (1 to 5), quality of life (Short Form-36), and survival rate were evaluated.

Results: Seventy-four patients had lung metastases, 5 had primary lung cancers, 16 had benign nodules, and 5 had Morgani’s hernia. Five patients needed conversion to thoracotomy, whereas 7 successfully underwent a second transxiphoid operation. Sixty-five metastatic patients were bilaterally explored, 44 were without radiologic evidence of controlateral lesions, discovering 23 occult metastases and 10 patients with occult controlateral disease. A total of 207 minimal resections and 11 lobectomies were performed. Mean operative time was 103 ± 35 minutes. We had no intraoperative mortality or major complications. Thirty-day postoperative morbidity documented arrhythmia (n = 4) and acute pneumonia (n = 4). Visual Analogue Scale pain, C-reactive protein, fibrinogen, and serum interleukin-6, -8, and -10 normalized within 72 hours. Respiratory function and most of the Short Form-36 domains recovered within 3 months. Six-month mean patient satisfaction score was 4.0 ± 0.8. Three- and 5-year survival rates for metastatic patients were 52% and 43%, respectively. Mean disease-free interval was 12 ± 5.8 months.

Conclusions: Transxiphoid hand-assisted videothoracoscopy proved a good alternative to conventional approaches, and provided rapid recovery without affecting the survival rate in those patients with metastatic lesions. We recommend it whenever a handport during video-assisted procedure is required.

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Invited commentary

Frank C. Detterbeck
Ann. Thorac. Surg. 2007 83: 1984-1985. [Extract] [Full Text] [PDF]

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				F. C. Detterbeck Invited commentary Ann. Thorac. Surg., June 1, 2007; 83(6): 1984 - 1985. [Full Text] [PDF]