Application of non-drainage tube in thoracoscopic mediastinal tumor resection through the subxiphoid approach: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Xianchao , TANG Bo , HUANG Yun

Department of Cardiothoracic Surgery, The Fourth People's Hospital of Zigong City, Zigong, 643000, Sichuan, P. R. China;

Corresponding author：

CHEN Xianchao, Email: 472926194@qq.com

Keywords：

Non-drainage tube; thoracoscopic surgery; subxiphoid approach; mediastinal tumor resection

DOI：

10.7507/1007-4848.202406043

Video：

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Objective To explore the clinical application effects of using no drainage tube in mediastinal tumor resection via thoracoscopic subxiphoid approach. Methods A retrospective analysis was conducted on the clinical data of patients who underwent mediastinal tumor resection via thoracoscopic subxiphoid approach at the Fourth People's Hospital of Zigong City from January 2020 to February 2024. Patients were divided into a non-drainage tube group and a drainage tube group, and their perioperative data were compared. Results A total of 149 patients were included, and there were 111 patients of thymoma, 5 patients of teratoma, and 33 patients of cyst. There were 77 patients in the non-drainage tube group, including 40 males and 37 females, aged 28-79 (53.72±13.34) years; there were 72 patients in the drainage tube group, including 33 males and 39 females, aged 26-80 (55.60±11.06) years. The differences in postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative drainage tube-related complications, and the number of temporary analgesics used after surgery between the two groups were statistically significant (P<0.05). Conclusion The use of non-drainage tube technology in mediastinal tumor resection through thoracoscopic subxiphoid approach can reduce postoperative pain and the number of temporary analgesics used, as well as decrease the incidence of drainage tube-related complications.

1.	李仁鹏, 黎琰, 胡文滕, 等. 截石位经剑突下入路与侧卧位经肋间入路胸腔镜下前纵隔肿物切除术的临床分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1171-1175.Li RP, Li Y, Hu WT, et al. Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(12): 1171-1175.
2.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
3.	Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
4.	Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
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6.	Zhu X, Jin K, Wu X, et al. Clinical application of thoracoscopic resection of anterior mediastinal tumors under the xiphoid process. Biomed Res Int, 2022, 2022: 2012457.
7.	Zhang S, Chen Z, Li B, et al. Efficiency of ectopic thymectomy by three surgical approaches in non-thymomatous myasthenia gravis. Updates Surg, 2022, 74(4): 1435-1443.
8.	Nawojowska A, Mendes S, Cabral D, et al. Results of minimally invasive vats thymectomy in miastenia gravis patients compared with more invasive approaches: 10-year experience in a single center. Port J Card Thorac Vasc Surg, 2024, 31(1): 23-28.
9.	Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardiovasc Surg, 2014, 62(8): 468-474.
10.	Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis. Int J Surg, 2019, 67: 13-17.
11.	Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: Robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
12.	Chao YK, Lee JY, Lu HI, et al. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: A multi-institutional study. J Robot Surg, 2024, 18(1): 21.
13.	Deng J, She Y, Zhao M, et al. Simultaneously thoracoscopic resection of lung cancer and anterior mediastinal lesions by video-assisted thoracoscopic surgery. Ann Transl Med, 2019, 7(14): 333.
14.	Xu J, Xu Y, Zhang R. Thoracoscopic resection of a cavernous haemangioma of anterior mediastinum: Case report and literature review. Mediastinum, 2023, 7: 30.
15.	Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2020, 93(1): 334-336.
16.	Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
17.	Wang S, Yang X, Jiang J, et al. Subxiphoid versus lateral intercostal thoracoscopic thymectomy for suspected thymoma: Results of a randomized controlled trial. J Thorac Cardiovasc Surg, 2024, 168(1): 290-298.
18.	Qiu Z, Chen L, Lin Q, et al. Perioperative outcomes and mid-term effects in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis: Subxiphoid versus right thoracic approaches. J Thorac Dis, 2020, 12(4): 1529-1539.

1. 李仁鹏, 黎琰, 胡文滕, 等. 截石位经剑突下入路与侧卧位经肋间入路胸腔镜下前纵隔肿物切除术的临床分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1171-1175.Li RP, Li Y, Hu WT, et al. Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(12): 1171-1175.
2. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
3. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
4. Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
5. Mao Y, Lan Y, Cui F, et al. Comparison of different surgical approaches for anterior mediastinal tumor. J Thorac Dis, 2020, 12(10): 5430-5439.
6. Zhu X, Jin K, Wu X, et al. Clinical application of thoracoscopic resection of anterior mediastinal tumors under the xiphoid process. Biomed Res Int, 2022, 2022: 2012457.
7. Zhang S, Chen Z, Li B, et al. Efficiency of ectopic thymectomy by three surgical approaches in non-thymomatous myasthenia gravis. Updates Surg, 2022, 74(4): 1435-1443.
8. Nawojowska A, Mendes S, Cabral D, et al. Results of minimally invasive vats thymectomy in miastenia gravis patients compared with more invasive approaches: 10-year experience in a single center. Port J Card Thorac Vasc Surg, 2024, 31(1): 23-28.
9. Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardiovasc Surg, 2014, 62(8): 468-474.
10. Zhang L, Li M, Jiang F, et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis. Int J Surg, 2019, 67: 13-17.
11. Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: Robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
12. Chao YK, Lee JY, Lu HI, et al. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: A multi-institutional study. J Robot Surg, 2024, 18(1): 21.
13. Deng J, She Y, Zhao M, et al. Simultaneously thoracoscopic resection of lung cancer and anterior mediastinal lesions by video-assisted thoracoscopic surgery. Ann Transl Med, 2019, 7(14): 333.
14. Xu J, Xu Y, Zhang R. Thoracoscopic resection of a cavernous haemangioma of anterior mediastinum: Case report and literature review. Mediastinum, 2023, 7: 30.
15. Suda T, Sugimura H, Tochii D, et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg, 2020, 93(1): 334-336.
16. Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
17. Wang S, Yang X, Jiang J, et al. Subxiphoid versus lateral intercostal thoracoscopic thymectomy for suspected thymoma: Results of a randomized controlled trial. J Thorac Cardiovasc Surg, 2024, 168(1): 290-298.
18. Qiu Z, Chen L, Lin Q, et al. Perioperative outcomes and mid-term effects in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis: Subxiphoid versus right thoracic approaches. J Thorac Dis, 2020, 12(4): 1529-1539.

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