Multiportal subxiphoid thoracoscopic major pulmonary resections.

backgroundNew subxiphoid video-assisted thoracoscopic surgery (SVATS) approaches are emerging for major pulmonary resection. The underlying concept is to reduce invasiveness and morbidity, by minimising intercostal nerve trauma, without any concession on safety and carcinologic issues. This study describes and evaluates our initial experience in multiportal SVATS, compared to conventional VATS (CVATS).

methodsBetween June 2016 and October 2017, 75 consecutive patients underwent major pulmonary resection with an original multiportal SVATS approach developed through a single or double access under the costal arch, unsystematically associated with intercostal ports for 5-mm instruments only. We retrospectively compared results of this SVATS group (n=75) against an historic CVATS group (n=75).

resultsFifty-one lobectomies, 20 segmentectomies and 4 pneumonectomies were achieved through multiportal SVATS. Sixty-eight malignant lesions and 7 benign lesions were noted. All patients with primary lung cancer underwent R0 resection and complete lymphadenectomy, with 11% of clinical N0 upstaging. When compared, the SVATS and CVATS groups were similar in terms of demographics and pathology. No statistical differences were observed in terms of conversion (9%

conclusionsMultiportal SVATS is a safe, carcinologic and reproducible approach for major pulmonary resection. By avoiding intercostal strains, it enables a high compliance to opioid-free analgesic protocol, contributing to significantly shorter hospitalisation and better recovery, compared to CVATS.