Transxiphoid bilateral palpation in video-assisted thoracoscopic lung metastasectomy

Objective: To evaluate indications, limits, and merits of transxiphoid bilateral palpation during video-assisted thoracoscopy (VAT) lung metastasectomy. Design: Survey retrospective study with a minimum follow-up of 1 year. Setting: University hospital. Patients: From December 1995 to September 1999, 29 of 45 patients operated on for pulmonary metastasectomy were approached through a transxiphoid VAT. Primary sites were colon-rectum(n=13), kidney (n=4), limb osteosarcoma(n=3), uterus (n=2), larynx (n=2), breast (n=1), skin melanoma (n=1), prostate gland (n=1), back fibrosarcoma (n=1), and ovary (n=1). Bilateral palpation was performed in 23 patients, although only 10 had radiological evidence of bilateral disease. Results: No perioperative or 30-days postoperative mortality was recorded. Acute and chronic pain was similar to that of other VATs and significantly less than sternotomy. Mean+/-SD chest-drain time and hospital stay were 2.8 +/- 1.19 days and 4.3+/-1.78 days, respectively. Sixty-nine lesions, 60 of them metastatic, were resected by laser (n = 29) or stapler (n=40). Bilateral exploration permitted the discovery of 15 radiologically undetected lesions, 11 of which were found to be malignant. Contralateral metastases were found in 5 patients predicted to have unilateral disease. Mean+/-SD follow-up was 22.89 +/- 10.87 months (range, 9-60 months). Six patients developed new pulmonary: metastases after a mean interval of 13.6 months; 3 of these patients relapsed in the unexplored hemithorax after 6, 9, and 12 months, respectively. Conclusions: The use of the transxiphoid VAT approach was safe, applicable in many instances, and effective in detecting occult metastases by manual bilateral palpation. The advantages of a VAT procedure can be coupled with those provided by a radical operation.