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. © 2007 The Society of Thoracic Surgeons.
Mineo, T.c., Ambrogi, V., Mineo, D., Pompeo, E. (2007). Transxiphoid hand-assisted videothoracoscopic surgery. ANNALS OF THORACIC SURGERY, 83(6), 1978-1984 [10.1016/j.athoracsur.2007.02.021].
Transxiphoid hand-assisted videothoracoscopic surgery
MINEO, TOMMASO CLAUDIO;AMBROGI, VINCENZO;MINEO, DAVIDE;POMPEO, EUGENIO
2007-01-01
Abstract
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. © 2007 The Society of Thoracic Surgeons.Questo articolo è pubblicato sotto una Licenza Licenza Creative Commons