Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in anterior mediastinal masses_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Junmin ^1,2 , WANG Junjie ³ , YUE Jianming ⁴ , SUN Yixin ² , LIU Yichen ² , WANG Lei ¹ , ZHAO Lin ¹ , LI Jie ¹ , ZHAO Jinlan ⁵ , TU Xuehua ⁵ , DING Ningying ⁵ , HU Jianrong ⁵ , HE Chunmei ⁵ , TIAN Leilei ⁵ , TANG Hongtao ⁶ , ZHAO Jiasheng ⁷ , CHEN Cheng ⁸ , SONG Yongxiang ⁸ , TIAN Yunwei ⁹ , XIAO Yong ¹⁰ , LI Kaidi ¹ , MA Lin ¹ , WANG Yun ¹ , CHEN Longqi ¹ ,  TIAN Dong ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, P. R. China;
4. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
5. Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, P. R. China;
6. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
7. Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, 110000, P. R. China;
8. Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical School, Zunyi, 563100, Guizhou, P. R. China;
9. Department of Thoracic Surgery, Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, 610041, P. R. China;
10. Department of Thoracic Surgey, Sichuan Science City Hospital, Mianyang, 621900, Sichuan, P. R. China;

Corresponding author：

TIAN Dong, Email: 22tiandong@163.com

Keywords：

Tubeless technology; balance-shaped sternal elevation device; percutaneous suspension technique; anterior mediastinal masses; subxiphoid incision; uniportal video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.202505094

Video：

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Objective To assess the clinical value of a novel surgical technique——Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60-150 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. Conclusion The tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.

1.	Almeida PT, Heller D. Anterior Mediastinal Mass. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Daniel Heller declares no relevant financial relationships with ineligible companies. : StatPearls Publishing; 2024.
2.	Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
3.	Muaddi H, Hafid ME, Choi WJ, et al. Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg, 2021, 273(3): 467-473.
4.	Akçay O, Acar T, Cantay S, et al. Minimally invasive approach to pneumothorax: Single port or two ports? Turk J Thorac Cardiovasc Surg, 2020, 28(2): 347-351.
5.	Liberman M, Khereba M, Goudie E, et al. Cervical video-assisted thoracoscopic surgery using a flexible endoscope for bilateral thoracoscopy. Ann Thorac Surg, 2012, 93(4): 1321-1323.
6.	Mei LX, Wang YY, Chen Y, et al. Subxiphoid versus intercostal video-assisted thoracic surgery for lung resection: a meta-analysis. Minim Invasive Ther Allied Technol, 2022, 31(3): 359-369.
7.	O’Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
8.	Cooper JD, Al-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1988, 45(3): 242-247.
9.	Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
10.	Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: a pilot study. Gland Surg, 2019, 8(6): 657-662.
11.	赵金兰, 陈蔚洋, 林琳, 等. 胸腔镜剑突下单孔双拉钩与经剑突肋缘下三孔胸腺切除术治疗胸腺瘤的回顾性队列研究. 中国胸心血管外科临床杂志, 2025, 32(4): 1-6.Zhao JL, Chen WY, Lin L, et al. Subxiphoid uniportal approach using double sternum retractors versus subxiphoid and subcostal arch three-portal approach of video-assisted thoracoscopic surgery thymectomy for thymoma treatment: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 1-6.
12.	Chen W, Tang H, Yu Z, et al. Clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic thymectomy using a double sternum retractor versus conventional approaches. J Thorac Dis, 2025, 17(5): 3200-3209.
13.	赵金兰, 陈蔚洋, 何春梅, 等. “天平拉钩抬高胸骨法”在经剑突下单孔胸腔镜辅助前纵隔肿物切除术中的应用. 中国胸心血管外科临床杂志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, Application of "balance-shaped sternal elevation device" in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
14.	Zhao Y, Ma Y, Bai Z, et al. Comparison of central venous catheter thoracic drainage and traditional closed thoracic drainage following minimally invasive surgery for esophageal carcinoma: a retrospective analysis. J Cardiothorac Surg, 2023, 18: 267.
15.	Janík M, Juhos P, Lučenič M, et al. Non-intubated thoracoscopic surgery—pros and cons. Front Surg, 2021, 8: 801718.
16.	Liu Z, Yang R, Sun Y. Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask. Thorac Cardiovasc Surg, 2020, 68(05): 450-456.
17.	Cui W, Huang D, Liang H, et al. Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection. Gland Surg, 2021, 10(4): 1387-1396.
18.	范江, 陈龙奇. 胸骨抬高经剑突下入路前纵隔肿物胸腔镜手术中国专家共识. 中国胸心血管外科临床杂志, 2025, 32(7): 887-896.Fan J, Chen LQ. Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses. Chin J Thorac Cardiovasc Surg, 2025, 32(7): 887-896.
19.	Alcasid NJ, Vasic I, Brennan PG, et al. The clinical significance of open vs. minimally invasive surgical approaches in the management of thymic epithelial tumors and myasthenia gravis. Front Surg, 2024, 11: 1457029.
20.	闵苏, 何开华. 喉罩的临床应用与管理专家共识. 临床麻醉学杂志, 2024, 40(12): 1316-1320.Min S, He KH. Expert consensus on the clinical application and management of laryngeal mask airway. J Clin Anesthesiol, 2024, 40(12): 1316-1320.
21.	唐焕雨, 黄桁, 姜凯元, 等. 胸腺上皮性肿瘤手术治疗研究进展. 国际肿瘤学杂志, 2020, 47(11): 691-694.Tang HY, Huang H, Jiang KY, et al. Research progress in the surgical treatment of thymic epithelial tumors. Int J Oncol, 2020, 47(11): 691-694.
22.	Yang F, Chen L, Wang H, et al. Optimizing surgical precision: a comparative study of three-port vs. four-port robotic-assisted lobectomy for NSCLC. J Cardiothorac Surg, 2025, 20: 184.
23.	Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg, 1999, 67(1): 263-265.
24.	Detterbeck FC, Kaminski HJ, Blasberg JD, et al. Does thymectomy in adults have long-term health consequences? J Thorac Cardiovasc Surg, 2025, 169(3): 787-795.
25.	Suda T. Single-port thymectomy using a subxiphoid approach—surgical technique. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
26.	徐向南, 范江, 黄威. 剑突下拉钩单孔胸腔镜全胸腺切除术的技术要领—手术流程标准化. 中华胸心血管外科杂志, 2023, 39(5): 311-313.Xu XN, Fan J, Huang W. Technical essentials of uniportal subxiphoid thoracoscopic thymectomy with lifted sternum by hooker-standardization of surgical procedures. Chin J Thorac Cardiovasc Surg, 2023, 39(5): 311-313.
27.	张程程, 吴亮, 范江. 治疗重症肌无力的新术式—剑突下双拉钩胸腔镜下胸腺扩大切除术. 中国临床新医学, 2023, 16(6): 547-51.Zhang CC, Wu L, Fan J, et al. A new surgical procedure for the treatment of myasthenia gravis—thoracoscopic extended thymectomy with double retractors subxiphoid. Chin J New Clin Med, 2023, 16(6): 547-51.
28.	Pompeo E, Mineo D, Rogliani P, et al. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg, 2004, 78(5): 1761-1768.
29.	He J, Liang H, Wang W, et al. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Transl Lung Cancer Res, 2021, 10(8): 3503-3519.
30.	Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov., 2015, 22(2): 123-30.
31.	刘星池, 许世广, 徐惟, 等. 完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用. 临床军医杂志, 2016, 44(6): 569-570.Liu XC, Xu SG, Xu W, et al. Application of completely tubeless da Vinci robotic mediastinal tumor resection in fast track surgery. Clin J Med Offic, 2016, 44(6): 569-570.
32.	王武平, 马洁, 陈召, 等. 喉罩与气管插管麻醉下“三孔式”非肌无力胸腺瘤切除术的对比研究. 中国胸心血管外科临床杂志, 2021, 28(1): 25-30.Wang WP, Ma J, Chen Z, et al. A comparative study of laryngeal mask and tracheal intubation anesthesia for "three port" thymectomy without myasthenia, Chin J Clin Thorac Cardiovasc Surg, 2021, 28(1): 25-30.
33.	Liu YW, Chen HW, Lee JY, et al. Is a chest tube necessary after video-assisted thoracoscopic mediastinal tumor resection? Thorac Cardiovasc Surg, 2021, 69(2): 181-188.

1. Almeida PT, Heller D. Anterior Mediastinal Mass. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Daniel Heller declares no relevant financial relationships with ineligible companies. : StatPearls Publishing; 2024.
2. Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol, 2016, 99: 332-350.
3. Muaddi H, Hafid ME, Choi WJ, et al. Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg, 2021, 273(3): 467-473.
4. Akçay O, Acar T, Cantay S, et al. Minimally invasive approach to pneumothorax: Single port or two ports? Turk J Thorac Cardiovasc Surg, 2020, 28(2): 347-351.
5. Liberman M, Khereba M, Goudie E, et al. Cervical video-assisted thoracoscopic surgery using a flexible endoscope for bilateral thoracoscopy. Ann Thorac Surg, 2012, 93(4): 1321-1323.
6. Mei LX, Wang YY, Chen Y, et al. Subxiphoid versus intercostal video-assisted thoracic surgery for lung resection: a meta-analysis. Minim Invasive Ther Allied Technol, 2022, 31(3): 359-369.
7. O’Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
8. Cooper JD, Al-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1988, 45(3): 242-247.
9. Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.
10. Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: a pilot study. Gland Surg, 2019, 8(6): 657-662.
11. 赵金兰, 陈蔚洋, 林琳, 等. 胸腔镜剑突下单孔双拉钩与经剑突肋缘下三孔胸腺切除术治疗胸腺瘤的回顾性队列研究. 中国胸心血管外科临床杂志, 2025, 32(4): 1-6.Zhao JL, Chen WY, Lin L, et al. Subxiphoid uniportal approach using double sternum retractors versus subxiphoid and subcostal arch three-portal approach of video-assisted thoracoscopic surgery thymectomy for thymoma treatment: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 1-6.
12. Chen W, Tang H, Yu Z, et al. Clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic thymectomy using a double sternum retractor versus conventional approaches. J Thorac Dis, 2025, 17(5): 3200-3209.
13. 赵金兰, 陈蔚洋, 何春梅, 等. “天平拉钩抬高胸骨法”在经剑突下单孔胸腔镜辅助前纵隔肿物切除术中的应用. 中国胸心血管外科临床杂志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, Application of "balance-shaped sternal elevation device" in the subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal masses resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
14. Zhao Y, Ma Y, Bai Z, et al. Comparison of central venous catheter thoracic drainage and traditional closed thoracic drainage following minimally invasive surgery for esophageal carcinoma: a retrospective analysis. J Cardiothorac Surg, 2023, 18: 267.
15. Janík M, Juhos P, Lučenič M, et al. Non-intubated thoracoscopic surgery—pros and cons. Front Surg, 2021, 8: 801718.
16. Liu Z, Yang R, Sun Y. Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask. Thorac Cardiovasc Surg, 2020, 68(05): 450-456.
17. Cui W, Huang D, Liang H, et al. Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection. Gland Surg, 2021, 10(4): 1387-1396.
18. 范江, 陈龙奇. 胸骨抬高经剑突下入路前纵隔肿物胸腔镜手术中国专家共识. 中国胸心血管外科临床杂志, 2025, 32(7): 887-896.Fan J, Chen LQ. Chinese expert consensus on subxiphoid video-assisted thoracoscopic surgery with sternal elevation for anterior mediastinal masses. Chin J Thorac Cardiovasc Surg, 2025, 32(7): 887-896.
19. Alcasid NJ, Vasic I, Brennan PG, et al. The clinical significance of open vs. minimally invasive surgical approaches in the management of thymic epithelial tumors and myasthenia gravis. Front Surg, 2024, 11: 1457029.
20. 闵苏, 何开华. 喉罩的临床应用与管理专家共识. 临床麻醉学杂志, 2024, 40(12): 1316-1320.Min S, He KH. Expert consensus on the clinical application and management of laryngeal mask airway. J Clin Anesthesiol, 2024, 40(12): 1316-1320.
21. 唐焕雨, 黄桁, 姜凯元, 等. 胸腺上皮性肿瘤手术治疗研究进展. 国际肿瘤学杂志, 2020, 47(11): 691-694.Tang HY, Huang H, Jiang KY, et al. Research progress in the surgical treatment of thymic epithelial tumors. Int J Oncol, 2020, 47(11): 691-694.
22. Yang F, Chen L, Wang H, et al. Optimizing surgical precision: a comparative study of three-port vs. four-port robotic-assisted lobectomy for NSCLC. J Cardiothorac Surg, 2025, 20: 184.
23. Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg, 1999, 67(1): 263-265.
24. Detterbeck FC, Kaminski HJ, Blasberg JD, et al. Does thymectomy in adults have long-term health consequences? J Thorac Cardiovasc Surg, 2025, 169(3): 787-795.
25. Suda T. Single-port thymectomy using a subxiphoid approach—surgical technique. Ann Cardiothorac Surg, 2016, 5(1): 56-58.
26. 徐向南, 范江, 黄威. 剑突下拉钩单孔胸腔镜全胸腺切除术的技术要领—手术流程标准化. 中华胸心血管外科杂志, 2023, 39(5): 311-313.Xu XN, Fan J, Huang W. Technical essentials of uniportal subxiphoid thoracoscopic thymectomy with lifted sternum by hooker-standardization of surgical procedures. Chin J Thorac Cardiovasc Surg, 2023, 39(5): 311-313.
27. 张程程, 吴亮, 范江. 治疗重症肌无力的新术式—剑突下双拉钩胸腔镜下胸腺扩大切除术. 中国临床新医学, 2023, 16(6): 547-51.Zhang CC, Wu L, Fan J, et al. A new surgical procedure for the treatment of myasthenia gravis—thoracoscopic extended thymectomy with double retractors subxiphoid. Chin J New Clin Med, 2023, 16(6): 547-51.
28. Pompeo E, Mineo D, Rogliani P, et al. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg, 2004, 78(5): 1761-1768.
29. He J, Liang H, Wang W, et al. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Transl Lung Cancer Res, 2021, 10(8): 3503-3519.
30. Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov., 2015, 22(2): 123-30.
31. 刘星池, 许世广, 徐惟, 等. 完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用. 临床军医杂志, 2016, 44(6): 569-570.Liu XC, Xu SG, Xu W, et al. Application of completely tubeless da Vinci robotic mediastinal tumor resection in fast track surgery. Clin J Med Offic, 2016, 44(6): 569-570.
32. 王武平, 马洁, 陈召, 等. 喉罩与气管插管麻醉下“三孔式”非肌无力胸腺瘤切除术的对比研究. 中国胸心血管外科临床杂志, 2021, 28(1): 25-30.Wang WP, Ma J, Chen Z, et al. A comparative study of laryngeal mask and tracheal intubation anesthesia for "three port" thymectomy without myasthenia, Chin J Clin Thorac Cardiovasc Surg, 2021, 28(1): 25-30.
33. Liu YW, Chen HW, Lee JY, et al. Is a chest tube necessary after video-assisted thoracoscopic mediastinal tumor resection? Thorac Cardiovasc Surg, 2021, 69(2): 181-188.

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Latest ArticlesTubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in anterior mediastinal masses

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