Transxiphoid hand-assisted videothoracoscopic surgery.
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 contralateral lesions, discovering 23 occult metastases and 10 patients with occult contralateral 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.
Mineo
Tommaso Claudio
TC
Thoracic Surgery Division, Policlinico Tor Vergata University, Rome, Italy.
Ambrogi
Vincenzo
V
Mineo
Davide
D
Pompeo
Eugenio
E
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010173:Palpation; D017060:Patient Satisfaction; D011788:Quality of Life; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods; D014989:Xiphoid Bone / Q000601:surgery
D015415:Biomarkers