P-165 * SUBXYPHOID UNIPORT VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR PULMONARY METASTASECTOMY

Abstract

Objectives: To report our experience of subxyphoid uninport video-assisted thoracoscopic surgery for pulmonary metastasectomy. Methods: In December 2013, 4 patients with pulmonary metastasis underwent subxyphoid uniport VATS for metastasectomy. Three cases underwent bilateral pulmonary metastasectomy. The metastases originated from hepatocellular carcinoma, nasopharyngeal carcinoma, colon adenocarcinoma, and breast cancer. After general anaesthesia with double-lumen ventilation, the patients were placed in supine position for bilateral disease and in semi-decubitus position for unilateral cases. The incision was made at the subxyphoid area and was about 3.5 cm in length. After blunt dissection by finger to create retrosternal space and to enter the bilateral pleural cavity, the low sternum was elevated slightly by the automatic surgical retractor system. One 2.5-6 cm wound protector was applied as the port. We used a 10-mm endoscope with adjustable viewing direction, and both thoracoscopic and laparoscopic surgery instruments to perform wedge resection or lobectomy. Results: Two lobectomy (1 right middle lobe, 1 right lower lobe) and 8 wedge resections (3 in left upper lobe, 3 in right lower lobe, and 2 in left lower lobe) were done in these 4 cases. In total 13 metastatic lesions were resected with free resection margin. The size of lung lesions ranged from 0.6 to 1.5 cm. The mean operative time was 174 min (range 105-230) with a mean blood loss of 45 ml (range 10-100). The chest tube was removed averagely 2.5 days (range 2-3) after the operation, and the mean postoperative hospital stay was 4.25 days (range 3-6). The average score of visual analogue scale for pain was 1.5 on first postoperative day, and reached zero 2 days after the operation. No complication was noted in these 4 cases. Conclusions: Subxyphoid uniport VATS for bilateral pulmonary metastasectomy is feasible, even to perform lobectomy, and it does provide minimal postoperative pain and a short hospital stay.