Ann Thorac Surg 2006;81:2337-2338
© 2006 The Society of Thoracic Surgeons
Correspondence
Reply
Maurizio Boaron, MD
Ospedale Maggiore Bologna ItalyOspedale Maggiore Largo Nigrisoli 2Bologna, 40122 Italy
(Email: maurizio.boaron{at}ausl.bologna.it).
To the Editor:
I would like to thank Dr Massetti and colleagues [1] for their interest in my work. I agree with them that the topic of limited sternotomy has been already largely studied. In my article [2], I acknowledged some of the previous studies focusing on different techniques of limited upper sternotomy [3, 4]. Similarly to my surgical technique, these ones were specifically designed for the exposure of the upper mediastinum and cervicothoracic junction. I use the technique (with the specifically designed retractor) for thymus, thyroid, and trachea surgery, as well as for biopsy or excision of anterior mediastinal masses. I use a limited cervicotomy associated with a partial sternal split (usually limited to the manubrium), and I use the specifically designed retractor whose blades open in a V-shaped fashion (instead of the standard parallel opening). As outlined in my article, this type of opening prevents uncontrolled sternal fractures. Furthermore, the lifting device, which may be connected to the self-retaining retractor to form an original joint system, provides an increase in the operative field and good exposition of the middle mediastinum thanks to the upward lifting of the sternum. In the technique of Massetti and colleagues [1], the whole bony portion of the sternum (manubrium and body) is cut through a midline skin incision starting at the level of the second or third intercostal space. The authors used this approach for cardiac operations or for resection of masses located in the anterior mediastinum behind the sternotomy [5, 6]. They advocate the use of a standard Tuffier [6] or of a specifically designed sternal retractor (MEDICON, Tuttlingen, Germany) [5, 6] whose blades open in the usual parallel fashion.
Although some overlap may exist between indications for a manubrial split (generally associated with a cervicotomy) or for a limited sternotomy (involving the whole manubrium and body) without cervicotomy, I think that approaching diseases with these two techniques are substantially different. The two retraction devices are also based on different concepts.
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References
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- Massetti M, Buklas D, Bichi S, Neri E. Minimally invasive thoracic retractors Ann Thorac Surg 2006;81:2336-2337.[Free Full Text]
- Boaron MA. A new retraction-suspension device for limited upper sternotomy Ann Thorac Surg 2004;77:1107-1108.[Abstract/Free Full Text]
- Bellows CF, Hartz RS, Cullinane C, Pigott JD. Cosmetic approach to anterior mediastinal masses Ann Thorac Surg 2002;74:1724-1726.[Abstract/Free Full Text]
- Grandjean JG, Lucchi M, Mariani MA. Reversed-T upper mini-sternotomy for extended thymectomy in myastenic patients Ann Thorac Surg 2000;70:1423-1425.[Abstract/Free Full Text]
- Massetti M, Babatasi G, Bhoyroo S, Le Page O, Khayat A. A special adapted retractor for the mini-sternotomy approach Ann Thorac Surg 1999;68:274-277.[Abstract/Free Full Text]
- Icard P, Le Page O, Massetti M, Alkofer B, Le Rochais JP, Khayat A. Resection of anterior mediastinal tumor through a ministernotomypreliminary experience with ten cases. J Thorac Cardiovasc Surg 2003;125:432-434.[Free Full Text]
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