Experience with thoracoscopic anatomical lung resections for malignant neoplasms from the subxiphoid approach

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Abstract
One of the challenges in thoracic surgery is the development of chronic pain syndrome following thoracoscopic procedures due to intercostal nerve injury. The use of spaces beneath the costal arch and subxiphoidally for placing “large” thoracoports is presented as an alternative approach to avoid this complication. Objective. To evaluate the immediate outcomes of thoracoscopic anatomical lung resections for malignant neoplasms performed via a subxiphoid approach. Material and Methods. The subxiphoid approach group included six patients, with a mean age of 67±5 years. Four surgical procedures in the form of lobectomy were performed for primary peripheral non-small cell lung cancer at stages IA3 and IB. Two segmentectomy procedures were conducted for solitary secondary lesions. The comparison group consisted of six patients aged 61±5 years, operated on using a multiport intercostal thoracoscopic technique for primary malignant lung tumors in the form of lobectomy. Results. The operative time in the subxiphoid approach group was 235±13 minutes, compared to 170±15 minutes in the comparison group. Blood loss volume was 125±15 ml and 75±15 ml, respectively. The postoperative period was uneventful in both groups. The mean hospital stay was 6.5±1.5 days in the subxiphoid group and 7.5±1.5 days in the comparison group. Pain intensity measured on the Visual Analogue Scale, (VAS) in the subxiphoid group was: day 1 — 3.5 points, day 3 — 2.5 points, discharge day — 1.5 points. In comparison, the intercostal multiport thoracoscopy group scored: day 1 — 4.5 points, day 3 — 3.5 points, discharge day — 2.5 points. Conclusion. The subxiphoid approach can be used for anatomical lung resection without compromising efficacy or safety. Performing thoracoscopic anatomical lung resections using a subxiphoid approach results in reduced postoperative pain compared to the traditional intercostal thoracoscopic approach.

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