Journal of thoracic disease · 2026
Technical nuances and early outcomes of uniportal subxiphoid video-assisted thoracoscopic surgery (VATS) for anterior mediastinal tumor resection without artificial pneumothorax: a retrospective analysis.
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Zhou Rui, Zhou Xingbo, Zhang Tong, Wang Kaiwang, Yang Zhiming, Lu Yanhong, Dai Lei, Zhang Gan, Xie Minghua, Zhou Jingyue, Zhang Anqing, Ren Zixue, Zhang Rongxin
Аннотация
BACKGROUND: The treatment of anterior mediastinal masses primarily utilizes video-assisted thoracoscopic surgery (VATS) through the lateral thoracic approach. This study introduced a subxiphoid uniportal VATS for anterior mediastinal tumor resection without artificial pneumothorax and analysed its technical nuances and early outcomes.
METHODS: A retrospective analysis was conducted on the clinical data of 52 patients with anterior mediastinal tumors admitted to Department of Thoracic Tumor Surgery, West District of the First Affiliated Hospital of University of Science and Technology of China, from January 2023 to August 2025. The cohort included 17 males and 35 females, with ages ranging from 16 to 79 years (mean, 53.15±13.88 years). The maximum tumor diameter ranged from 1.3 to 8.2 cm (mean, 3.41±1.76 cm). All patients underwent uniportal VATS tumor resection via a subxiphoid approach without carbon dioxide (CO2) artificial pneumothorax.
RESULTS: All 52 patients successfully completed the surgery without intraoperative hemorrhage, conversion to open thoracotomy, or phrenic nerve injury. There were no severe perioperative complications, such as massive intrathoracic bleeding, secondary surgery, or mortality. The operation time ranged from 30 to 201 minutes (mean, 101.19±42.45 minutes). The intraoperative blood loss was 10 to 100 mL (mean, 32.88±22.65 mL). Postoperative pleural drainage volume was 50 to 1,175 mL (mean, 357.73±246.55 mL), with a chest tube duration of 3 to 8 days (mean, 4.42±1.26 days). The postoperative hospital stay was 3 to 9 days (mean, 5.65±1.36 days).
CONCLUSIONS: For anterior mediastinal tumors with an intact capsule, no obvious invasion, and a maximum tumor diameter ≤5 cm, uniportal VATS via the subxiphoid approach without artificial pneumothorax is technically safe and feasible, with minimal surgical trauma, mild postoperative pain, and satisfactory short-term outcomes, and is therefore worthy of clinical application.
METHODS: A retrospective analysis was conducted on the clinical data of 52 patients with anterior mediastinal tumors admitted to Department of Thoracic Tumor Surgery, West District of the First Affiliated Hospital of University of Science and Technology of China, from January 2023 to August 2025. The cohort included 17 males and 35 females, with ages ranging from 16 to 79 years (mean, 53.15±13.88 years). The maximum tumor diameter ranged from 1.3 to 8.2 cm (mean, 3.41±1.76 cm). All patients underwent uniportal VATS tumor resection via a subxiphoid approach without carbon dioxide (CO2) artificial pneumothorax.
RESULTS: All 52 patients successfully completed the surgery without intraoperative hemorrhage, conversion to open thoracotomy, or phrenic nerve injury. There were no severe perioperative complications, such as massive intrathoracic bleeding, secondary surgery, or mortality. The operation time ranged from 30 to 201 minutes (mean, 101.19±42.45 minutes). The intraoperative blood loss was 10 to 100 mL (mean, 32.88±22.65 mL). Postoperative pleural drainage volume was 50 to 1,175 mL (mean, 357.73±246.55 mL), with a chest tube duration of 3 to 8 days (mean, 4.42±1.26 days). The postoperative hospital stay was 3 to 9 days (mean, 5.65±1.36 days).
CONCLUSIONS: For anterior mediastinal tumors with an intact capsule, no obvious invasion, and a maximum tumor diameter ≤5 cm, uniportal VATS via the subxiphoid approach without artificial pneumothorax is technically safe and feasible, with minimal surgical trauma, mild postoperative pain, and satisfactory short-term outcomes, and is therefore worthy of clinical application.