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Subxiphoid uniportal bilateral lung wedge resection

Subxiphoid uniportal bilateral lung wedge resection Abstract Subxiphoid uniportal bilateral lung wedge resection, in which all manipulations are performed via a 3-cm wound positioned below the xiphoid process, can be performed in the supine position without the patient having to change positions. It also enables one-stage bilateral lung resection. We report the surgical procedure and initial results of subxiphoid uniportal bilateral lung wedge resection. A 3-cm transverse incision was made 1 cm caudally below the xiphoid process. A port for uniportal surgery was inserted. After CO2 insufflation at 8 mmHg, the lung was grasped and lifted with bent grasping forceps, and by bending the tip of a stapler, the surgeon resected the affected portion of the bilateral lungs. In this approach, there is one incision, no intercostal nerve damage and bilateral surgery can be performed in the same procedure; therefore, the technique may have the benefit of lesser invasiveness for the patient. Furthermore, a detailed comparison of subxiphoid uniportal bilateral lung wedge resection with the one-stage lateral intercostal approach with a larger subject sample is needed. Minimally invasive surgery, Subxiphoid, Uniportal, Lung wedge resection INTRODUCTION In 2014, we reported a subxiphoid uniportal bilateral pulmonary metastasectomy [1]. This approach, in which all manipulations are performed via a 3-cm wound positioned below the xiphoid process, can be performed in the supine position without the patient having to change positions. It also enables one-stage bilateral lung resection. We report the surgical procedure and initial results of subxiphoid uniportal bilateral lung wedge resection (SUBLR). The study was approved by the Ethics Review Board of Fujita Health University (approval number: HM19-042). SUBXIPHOID UNIPORTAL BILATERAL LUNG WEDGE RESECTION The patient was placed in the supine position with legs apart. The surgeon stood between the patients’ legs, and the scopist stood at the right side of the patient. A video monitor was positioned at the head of the patient (Fig. 1 and Video 1). Video 1: Subxiphoid uniportal bilateral metastasectomy. Video 1: Subxiphoid uniportal bilateral metastasectomy. Close A 3-cm transverse incision was made 1 cm caudally below the xiphoid process. The surgeon inserted a finger behind the sternum and detached the thymus from the posterior surface of the sternum. The xiphoid process was not resected. A port for uniportal surgery (Lapsingle; Sejong Medical Co., Paju, Korea) was inserted. Such ports for uniportal surgery enable the insufflation of carbon dioxide (CO2 insufflation), and with three or four ports of 10–12 mm in size attached to a platform, a stapler can be inserted via a 12-mm port. After CO2 insufflation at 8 mmHg, the thymus was dissected from the posterior surface of the sternum using a vessel sealing device. An incision was made into the mediastinal pleura, and the thoracic cavity on the surgical side was exposed. Once the location of the lesion was confirmed, the lung was grasped and lifted with bent grasping forceps, and by bending the tip of an Endo GIA stapler (Covidien, Mansfield, MA, USA), the surgeon resected the affected portion of the lung with the bendable tip to avoid interference between the forceps and stapler. A sealing test was performed for each side separately because pooled water can cause ventilator insufficiency if this test was performed bilaterally. Through the subxiphoid wound, two 19-Fr BLAKE drains (Ethicon, Inc., Somerville, NJ, USA) were inserted, one on each side of the thoracic cavity. COMMENTS Of the 45 patients who underwent thoracoscopic bilateral lung wedge resection at Fujita Health University Hospital from March 2010 to May 2019, three patients who underwent another procedure concurrently were excluded (e.g. patients who underwent concurrent resection of another organ, those who underwent central venous catheter port enlargement). Patients were divided into the subxiphoid approach group (n = 6), the one-stage lateral intercostal approach group (n = 30) and the two-stage lateral intercostal approach group (n = 6). In one patient who underwent SUBLR (16.6%), an additional 12-mm port was placed in the 4th intercostal space on the anterior axillary line to palpate the margin from the tumour, and thus surgery was changed to a two-port procedure. No adverse events occurred intraoperatively. After surgery, a pulmonary air leak persisted in one patient (16.6%) who had undergone a one-stage lateral intercostal approach, for whom surgical closure of the pulmonary leak was performed. No other postoperative complications were observed, and no fatalities occurred. The patient background and perioperative results of each procedure are listed in Table 1. The subxiphoid approach and one-stage lateral intercostal approach tended to consume fewer analgesic tablets than a two-stage lateral intercostal approach. The subxiphoid approach and one-stage lateral intercostal approach used analgesics for a shorter time than the two-stage lateral intercostal approach. Fewer analgesic prescriptions were required 2 months after surgery via the subxiphoid approach than that of the lateral intercostal approach. SUBLR enables the surgeon to reach the thoracic cavity without passing through the ribs. Therefore, because no intercostal nerve damage is caused by the endoscope and forceps manipulations, less pain and numbness are expected and post-thoracotomy pain syndrome attributed to intercostal nerve damage does not occur [2]. Hospitalization costs were lower for the subxiphoid approach and one-stage lateral intercostal approach than for the two-stage lateral intercostal approach. Two-stage surgery increases the use of analgesics, lengthens the duration of treatment and increases the duration of surgery and therefore increases medical costs. Two-stage surgery is performed because the patient is at risk for complications or because bilateral resection performed simultaneously is more invasive. Because the subxiphoid approach causes no intercostal nerve damage and is less invasive, SUBLR may be more appropriate for patients at high risk of perioperative complications. Surgeons must remember that pressure on the heart caused by the forceps and the endoscope can induce arrhythmia [3]. In conclusion, SUBLR is a procedure that enables one-stage bilateral lung resection and does not cause intercostal nerve damage. Our findings suggest that in comparison with the two-stage lateral intercostal approach, SUBLR might shorten treatment duration and lower medical costs. Furthermore, a detailed comparison of SUBLR with the one-stage lateral intercostal approach with a larger subject sample is needed. Table 1: Patient background and perioperative outcomes . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 SE: standard error. Open in new tab Table 1: Patient background and perioperative outcomes . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 SE: standard error. Open in new tab Conflict of interest: none declared. Reviewer information European Journal of Cardio-Thoracic Surgery thanks Rui Haddad, Lei Jiang and the other, anonymous reviewer(s) for their contribution to the peer-review process of this article. Figure 1: Open in new tabDownload slide Subxiphoid uniportal bilateral lung wedge resection. Figure 1: Open in new tabDownload slide Subxiphoid uniportal bilateral lung wedge resection. Presented at the 7th Asian Single Port VATS Symposium, Nagoya, Japan, 24–25 May 2019. REFERENCES 1 Suda T , Ashikari S, Tochii S, Sugimura H, Hattori Y. Single-incision subxiphoid approach for bilateral metastasectomy . Ann Thorac Surg 2014 ; 97 : 718 – 19 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Cai H , Xie D, Al Sawalhi S, Jiang L, Zhu Y, Jiang G et al. Subxiphoid versus intercostal uniportal video-assisted thoracoscopic surgery for bilateral lung resections: a single-institution experience . Eur J Cardiothorac Surg 2020 ; 57 : 343 – 9 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 3 Hernandez-Arenas LA , Guido W, Jiang L. Learning curve and subxiphoid lung resections most common technical issues . J Vis Surg 2016 ; 2 : 117 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Subxiphoid uniportal bilateral lung wedge resection

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Oxford University Press
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© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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1010-7940
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10.1093/ejcts/ezaa169
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Abstract

Abstract Subxiphoid uniportal bilateral lung wedge resection, in which all manipulations are performed via a 3-cm wound positioned below the xiphoid process, can be performed in the supine position without the patient having to change positions. It also enables one-stage bilateral lung resection. We report the surgical procedure and initial results of subxiphoid uniportal bilateral lung wedge resection. A 3-cm transverse incision was made 1 cm caudally below the xiphoid process. A port for uniportal surgery was inserted. After CO2 insufflation at 8 mmHg, the lung was grasped and lifted with bent grasping forceps, and by bending the tip of a stapler, the surgeon resected the affected portion of the bilateral lungs. In this approach, there is one incision, no intercostal nerve damage and bilateral surgery can be performed in the same procedure; therefore, the technique may have the benefit of lesser invasiveness for the patient. Furthermore, a detailed comparison of subxiphoid uniportal bilateral lung wedge resection with the one-stage lateral intercostal approach with a larger subject sample is needed. Minimally invasive surgery, Subxiphoid, Uniportal, Lung wedge resection INTRODUCTION In 2014, we reported a subxiphoid uniportal bilateral pulmonary metastasectomy [1]. This approach, in which all manipulations are performed via a 3-cm wound positioned below the xiphoid process, can be performed in the supine position without the patient having to change positions. It also enables one-stage bilateral lung resection. We report the surgical procedure and initial results of subxiphoid uniportal bilateral lung wedge resection (SUBLR). The study was approved by the Ethics Review Board of Fujita Health University (approval number: HM19-042). SUBXIPHOID UNIPORTAL BILATERAL LUNG WEDGE RESECTION The patient was placed in the supine position with legs apart. The surgeon stood between the patients’ legs, and the scopist stood at the right side of the patient. A video monitor was positioned at the head of the patient (Fig. 1 and Video 1). Video 1: Subxiphoid uniportal bilateral metastasectomy. Video 1: Subxiphoid uniportal bilateral metastasectomy. Close A 3-cm transverse incision was made 1 cm caudally below the xiphoid process. The surgeon inserted a finger behind the sternum and detached the thymus from the posterior surface of the sternum. The xiphoid process was not resected. A port for uniportal surgery (Lapsingle; Sejong Medical Co., Paju, Korea) was inserted. Such ports for uniportal surgery enable the insufflation of carbon dioxide (CO2 insufflation), and with three or four ports of 10–12 mm in size attached to a platform, a stapler can be inserted via a 12-mm port. After CO2 insufflation at 8 mmHg, the thymus was dissected from the posterior surface of the sternum using a vessel sealing device. An incision was made into the mediastinal pleura, and the thoracic cavity on the surgical side was exposed. Once the location of the lesion was confirmed, the lung was grasped and lifted with bent grasping forceps, and by bending the tip of an Endo GIA stapler (Covidien, Mansfield, MA, USA), the surgeon resected the affected portion of the lung with the bendable tip to avoid interference between the forceps and stapler. A sealing test was performed for each side separately because pooled water can cause ventilator insufficiency if this test was performed bilaterally. Through the subxiphoid wound, two 19-Fr BLAKE drains (Ethicon, Inc., Somerville, NJ, USA) were inserted, one on each side of the thoracic cavity. COMMENTS Of the 45 patients who underwent thoracoscopic bilateral lung wedge resection at Fujita Health University Hospital from March 2010 to May 2019, three patients who underwent another procedure concurrently were excluded (e.g. patients who underwent concurrent resection of another organ, those who underwent central venous catheter port enlargement). Patients were divided into the subxiphoid approach group (n = 6), the one-stage lateral intercostal approach group (n = 30) and the two-stage lateral intercostal approach group (n = 6). In one patient who underwent SUBLR (16.6%), an additional 12-mm port was placed in the 4th intercostal space on the anterior axillary line to palpate the margin from the tumour, and thus surgery was changed to a two-port procedure. No adverse events occurred intraoperatively. After surgery, a pulmonary air leak persisted in one patient (16.6%) who had undergone a one-stage lateral intercostal approach, for whom surgical closure of the pulmonary leak was performed. No other postoperative complications were observed, and no fatalities occurred. The patient background and perioperative results of each procedure are listed in Table 1. The subxiphoid approach and one-stage lateral intercostal approach tended to consume fewer analgesic tablets than a two-stage lateral intercostal approach. The subxiphoid approach and one-stage lateral intercostal approach used analgesics for a shorter time than the two-stage lateral intercostal approach. Fewer analgesic prescriptions were required 2 months after surgery via the subxiphoid approach than that of the lateral intercostal approach. SUBLR enables the surgeon to reach the thoracic cavity without passing through the ribs. Therefore, because no intercostal nerve damage is caused by the endoscope and forceps manipulations, less pain and numbness are expected and post-thoracotomy pain syndrome attributed to intercostal nerve damage does not occur [2]. Hospitalization costs were lower for the subxiphoid approach and one-stage lateral intercostal approach than for the two-stage lateral intercostal approach. Two-stage surgery increases the use of analgesics, lengthens the duration of treatment and increases the duration of surgery and therefore increases medical costs. Two-stage surgery is performed because the patient is at risk for complications or because bilateral resection performed simultaneously is more invasive. Because the subxiphoid approach causes no intercostal nerve damage and is less invasive, SUBLR may be more appropriate for patients at high risk of perioperative complications. Surgeons must remember that pressure on the heart caused by the forceps and the endoscope can induce arrhythmia [3]. In conclusion, SUBLR is a procedure that enables one-stage bilateral lung resection and does not cause intercostal nerve damage. Our findings suggest that in comparison with the two-stage lateral intercostal approach, SUBLR might shorten treatment duration and lower medical costs. Furthermore, a detailed comparison of SUBLR with the one-stage lateral intercostal approach with a larger subject sample is needed. Table 1: Patient background and perioperative outcomes . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 SE: standard error. Open in new tab Table 1: Patient background and perioperative outcomes . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 . Subxiphoid approach . One-stage lateral intercostal approach . Two-stage lateral intercostal approach . Number of patients, n (%) 6 (14.2) 30 (77.0) 6 (14.2) Age (years), average ± SE 44.5 ± 8.5 49.7 ± 3.8 60.3 ± 8.5 Sex, n (%)  Male 5 (83.3) 20 (66.7) 2 (33.3)  Female 1 (16.7) 10 (33.3) 4 (66.7) Diagnosis, n (%)  Pneumothorax 2 (33.3) 6 (20.0) 0  Metastasis lung cancer 4 (66.7) 24 (80.0) 6 (100) Number of resections, average ± SE 2.3 ± 0.4 2.6 ± 0.2 4.1 ± 0.4 Duration of surgery (min), average ± SE 145.2 ± 34.5 142.4 ± 47.6 176.1 ± 79.3 Blood loss volume (g), average ± SE 5.3 ± 2.9 21.3 ± 33.5 15.5 ± 9.7 Total number of analgesic tablets used (tablets), average ± SE 52.5 ± 24.6 88.4 ± 44.9 195.0 ± 59.4 Duration of oral analgesic use (days), average ± SE 17.5 ± 8.2 30.2 ± 15.0 65.3 ± 48.5 Time to treatment completion (days), average ± SE 27.0 ± 12.3 32.7 ± 12.7 78.5 ± 14.7 Hospitalization costs (EUR), average ± SE 15 952 ± 2049 16 835 ± 2671 20 280 ± 1332 SE: standard error. Open in new tab Conflict of interest: none declared. Reviewer information European Journal of Cardio-Thoracic Surgery thanks Rui Haddad, Lei Jiang and the other, anonymous reviewer(s) for their contribution to the peer-review process of this article. Figure 1: Open in new tabDownload slide Subxiphoid uniportal bilateral lung wedge resection. Figure 1: Open in new tabDownload slide Subxiphoid uniportal bilateral lung wedge resection. Presented at the 7th Asian Single Port VATS Symposium, Nagoya, Japan, 24–25 May 2019. REFERENCES 1 Suda T , Ashikari S, Tochii S, Sugimura H, Hattori Y. Single-incision subxiphoid approach for bilateral metastasectomy . Ann Thorac Surg 2014 ; 97 : 718 – 19 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Cai H , Xie D, Al Sawalhi S, Jiang L, Zhu Y, Jiang G et al. Subxiphoid versus intercostal uniportal video-assisted thoracoscopic surgery for bilateral lung resections: a single-institution experience . Eur J Cardiothorac Surg 2020 ; 57 : 343 – 9 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 3 Hernandez-Arenas LA , Guido W, Jiang L. Learning curve and subxiphoid lung resections most common technical issues . J Vis Surg 2016 ; 2 : 117 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Aug 1, 2020

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