Surgical outcomes of thoracoscopic thymectomy via the single-port subxiphoid approach versus the unilateral intercostal approach

Joonseok Lee, Sukki Cho, Seung Hwan Yoon, Beatrice Chia Hui Shih, Woohyun Jung, Jae Hyun Jeon, Kwhanmien Kim, Sanghoon Jheon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives: The purpose of this study was to explore the safety and feasibility of video-assisted thoracic surgery (VATS) total thymectomy via the single-port subxiphoid approach compared with the intercostal approach Methods: From January 2018 to May 2022, patients who underwent VATS total thymectomy via the subxiphoid or unilateral intercostal approach and diagnosed with Masaoka-Koga stage I-II, non-myasthenic thymoma were included in this study. Perioperative outcomes, immediate and long-term pain evaluations were compared in a propensity score-matching analysis. Results: In total, 95 patients were included and underwent the subxiphoid approach (n = 37) and the intercostal approach (n = 58). Propensity score yielded 2 well-matched cohorts of 30 patients and there was no significant demographical imbalance between the 2 groups. Compared with the intercostal approach, the subxiphoid group demonstrated favourable perioperative outcomes including the intraoperative blood loss (P = 0.025) and the median duration of hospital stay (P = 0.083). The immediate and long-term pain evaluations revealed that the subxiphoid group reported lower visual analogue scales at postoperative 24 h and lower total doses of fentanyl bolus infusions during hospitalization (P = 0.004 and 0.018, respectively), along with lower long-term neuropathic pain scale scores (P = 0.005) than patients in the intercostal group. Conclusions: VATS thymectomy via the single-port subxiphoid approach showed favourable perioperative outcomes compared to the intercostal approach. Moreover, the subxiphoid approach seemed both to cause minimal immediate postoperative pain and to have advantages in reducing long-term neuropathic pain compared with the intercostal approach.

Original languageEnglish
Article numberivad141
JournalInterdisciplinary cardiovascular and thoracic surgery
Volume37
Issue number4
DOIs
StatePublished - 1 Oct 2023

Bibliographical note

Publisher Copyright:
© 2023 Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Keywords

  • Intercostal approach
  • Subxiphoid approach
  • Thymectomy
  • Video-assisted thoracic surgery

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