Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access

Complete resection of pulmonary metastases remains the standard of care for selected patients. An open approach causes criticism because of aggressiveness. Without manual palpation the video-assisted thoracic surgery procedure has the high probability of missing occult metastases. Transxiphoid bilateral lung metastasectomy surgery has not been widely adopted. We developed a hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through natural sternocostal triangle access in 2001 to solve the problems mentioned previously.

We retrospectively evaluated 55 consecutive patients between 2001 and 2009 who underwent hand-assisted thoracoscopic surgery through sternocostal triangle access for pulmonary metastasis. Complications after operation, operative time, operative bleeding, air leak days, length of stay, preoperation imaging examination, and survival rate were evaluated.

Fifty-five patients had lung metastases. Bilateral explorations were performed in a total of 51 patients, with a total of 201 minimal resections and one lobectomy. Nearly half of the patients with bilateral metastases were misdiagnosed as unilateral metastases by imaging examination. Intraoperative cardiac arrhythmia was experienced in 5.2% of the right and 10.5% of the left approaches. Postoperative complication rate was 3.6%. Three-year and five-year overall survival rates for metastatic disease were 59.8% and 47.2%, respectively.

This new surgical procedure, with an assisted hand, could complete bilateral pleural exploration in a single operation through the natural sternocostal triangle. It is easy to perform and may help the patients gain a faster rehabilitation. Furthermore, it may lead to a better survival.