The Shanghai Pulmonary Hospital uniportal subxiphoid approach for lung segmentectomies

Lung segmentectomy may be considered an oncologic equivalent treatment to lobectomy for non-small cell lung cancer (NSCLC) sized 20 mm or smaller. Subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) could further improve the surgical outcome reducing the surgical stress and completely avoiding the intercostal nerve injury. The aim of this manuscript is to illustrate the Shanghai Pulmonary Hospital surgical techniques for uniportal subxiphoid VATS (SVATS) segmentectomies.

A total of 79 consecutive patients underwent 84 subxiphoid segmentectomies for malignant or benign pulmonary diseases between September 2014 and January 2016. We here illustrate the surgical techniques and the early results.

There were 45 segmentectomies in right-side group and 39 segmentectomies left-side group. The mean operation time was 2.38±0.77 hours, and mean operative blood loss was 126.09±136.17 mL. Nine segmentectomies (10.7%) had an intra-operative change of procedure and four were converted to thoracotomy, one had a lobectomy rather than a segmentectomy and four were converted to conventional VATS lobectomy. A total of 12 patients (15.1%) had postoperative complications, including 1 hematoma, 4 prolonged air-leaks and 8 arrhythmias.

In the presented series that included our learning curve period we have experienced relative low conversion rates and few post-operatively complications showing that, SVATS segmentectomy can be considered a safe procedure with a relative low rate early post-operative complication.