Clinical application of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Zhengwei , YIN Xunliang ,  ZHOU Yongan

Department of Thoracic Surgery, Tangdu Hospital of the Fourth Military Medical University, Xi’an, 710038, P.R.China;

Corresponding?author：

ZHOU Yongan, Email: zhou.yongan@163.com

Keywords：

Thoracoscopic surgery; harmonic scalpel; subxiphoid and subcostal arch; anterior mediastinal lesion

DOI：

10.7507/1007-4848.201711048

Video：

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Objective To evaluate the clinical outcomes of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion. Methods We retrospectively analyzed the clinical data of 217 patients with anterior mediastinal lesion at the Department of Thoracic Surgery of Tangdu Hospital of the Fourth Military Medical University from June 2015 to June 2017, among whom 162 underwent thoracoscopic surgery via subxiphoid and subcostal arch approach with harmonic scalpel (a harmonic scalpel group, 95 males and 67 females at an average age of 46.2±18.7 years ranging from 22 to 72 years) and 55 with Ligasure (a Ligasure group, 29 males and 26 females at an average age of 47.7±12.9 years ranging from 31 to 68 years). Operation time, intraoperative blood loss, intraoperative conversion rate, postoperative hospital stay, patients satisfaction score, patients pain score and postoperative complications were compared between both groups. Results All operations were accomplished successfully, and there was no death or conversion to thoracotomy. There was a statistical difference in operation time (58.6±34.8 min vs. 72.8±32.6 min, P=0.01), and intraoperative blood loss (36.2±18.7 ml vs. 41.9±12.9 ml, P=0.04). There was no statistical difference between the two groups in length of hospital stay (4.2±2.6 d vs. 4.5±1.9 d, P=0.36), pain score at postoperative day 1, 3 and 30 (8.3±0.9 vs. 8.5±0.6, P=0.13; 6.4±1.5 vs. 6.9±1.1, P=0.19; 1.3±0.7 vs. 1.4±0.9, P=0.40), patients’ satisfaction score (8.6±1.2 vs. 8.4±1.7, P=0.34), or incidence of postoperative complications (5.6% vs. 9.1%, P=0.35). Conclusion Harmonic scalpel plays an important role in resection of anterior mediastinal lesion via subxiphoid and subcostal arch approach. All tissues are separated and blood vessels are dissected only by the harmonic scalpel, so it is very important for us to handle the harmonic scalpel skillfully.

Citation： ZHAO Zhengwei, YIN Xunliang, ZHOU Yongan. Clinical application of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 23-27. doi: 10.7507/1007-4848.201711048 Copy

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12.	Sonett JR, Jaretzki A 3rd. Thymectomy for nonthymomatous myasthenia gravis: a critical analysis. Ann N Y Acad Sci, 2008, 1132: 315-328.
13.	尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
14.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11: S240-S252.
15.	Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.

1. 趙正維, 王海強, 周勇安, 等. 前縱隔病變微創切除手術的治療進展. 醫學綜述, 2016, 22(24): 4856-4859.
2. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
3. 盧強, 李小飛, 趙晉波, 等. " 三孔式”經劍突肋緣下胸腺切除治療重癥肌無力. 中華胸部外科電子雜志, 2016, 3(2): 95-99.
4. Yuan ZY, Cheng GY, Sun KL, et al. Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center. J Thorac Dis, 2014, 6(6): 726-733.
5. Trivi?o A, Congregado M, Loscertales J, et al. Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma. Cir Esp, 2015, 93(7): 466-471.
6. 周勇安, 趙晉波, 吳昱, 等. 胸腺瘤合并重癥肌無力的外科治療. 現代腫瘤醫學, 2009, 17(3): 455-456.
7. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-S264.
8. 李敘, 魏小東, 栗蘭凱, 等. 超聲刀在胸部創傷胸腔鏡手術中的應用. 創傷外科雜志, 2011, 13(5): 393-394.
9. 中國醫師協會胸外科醫師分會微創外科專家委員會, 劉倫旭, 李印, 胡堅, 等. 胸腔鏡手術超聲刀規范使用專家共識(2017 版). 中國胸心血管外科臨床雜志, 2017, 24(6): 407-412.
10. Roye GD, Monchik J, Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating. Surg Technol Int, 2000, IX: 129-138.
11. 康小芳, 仲偉國. 腹腔鏡手術中不同止血方法優缺點的比較. 腹腔鏡外科雜志, 2008, 13(1): 78-81.
12. Sonett JR, Jaretzki A 3rd. Thymectomy for nonthymomatous myasthenia gravis: a critical analysis. Ann N Y Acad Sci, 2008, 1132: 315-328.
13. 尹遜亮, 周勇安, 趙寧, 等. 單孔及多孔法胸腔鏡手術治療周圍型非小細胞肺癌臨床療效的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(11): 1044-1049.
14. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11: S240-S252.
15. Jensen MP, Karoly P, O'Riordan EF, et al. The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain, 1989, 5(2): 153-159.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion

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