Subxiphoid single-incision thoracoscopic surgery for bilateral primary spontaneous pneumothorax

Chao-Yu Liu, Chen-Sung Lin, Chia-Chuan Liu, Chao-Yu Liu, Chen-Sung Lin, Chia-Chuan Liu

Abstract

It has been reported that single-incision thoracoscopic surgery can reduce postoperative pain without compromising the main surgical steps required for treating patients affected by primary spontaneous pneumothorax. However, all the reported thoracoscopic surgery cases with a single-incision procedure were via the intercostal route for unilateral pulmonary lesions. We present a novel single-incision thoracoscopic technique via a subxiphoid route to perform one-stage bilateral thoracoscopic surgery for bilateral spontaneous pneumothorax. Reduced postoperative pain, shorter operative time, and better cosmetic results are potential benefits of this technique in selected patients. The subxiphoid single-incision procedure may be indicated in patients with bilateral pulmonary lesions requiring surgical resections.

Keywords: pneumothorax; single-incision; subxiphoid.

Figures

Photo 1
Photo 1
A – Patient has a history of left primary spontaneous pneumothorax (PSP) without previous surgical intervention. B – Contralateral recurrence of PSP associated with hemothorax. C – Chest CT revealed groups of blebs at apex of right lung (arrow)
Photo 2
Photo 2
A – 3-cm longitudinal midline incision was made immediately below the sternocostal triangle (the level of the xiphoid process). The infrasternal angle (arrow) is the landmark for entry to bilateral chest cavities. B – Two chest tubes were placed via the incision with one to the right side (the lower one) and one to the left side (the upper one) chest cavity
Photo 3
Photo 3
Instrumental positioning and intraoperative findings. A – For the right side procedure, operator and assistant stand on the left side of the patient with the table 30° off center, tilted to the left. B – For the left side procedure, operator and assistant stand on the right side of the patient with the table tilted 30° to the right

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Source: PubMed

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