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 , LIN 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 University, 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 Surgery, 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 60.0-150.0 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, Chief Editor. Anterior Mediastinal Mass. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2024 Apr 19].
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.	Ak?ay 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.	趙金蘭, 陳蔚洋, 林琳, 等. 胸腔鏡劍突下單孔雙拉鉤與經劍突肋緣下三孔胸腺切除術治療胸腺瘤的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2025, 32(4): 482-487.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): 482-487.
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.	趙金蘭, 陳蔚洋, 何春梅, 等. “天平拉鉤抬高胸骨法”在經劍突下單孔胸腔鏡輔助前縱隔腫物切除術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al, 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, Lu?eni? 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, 陳龍奇. 胸骨抬高經劍突下入路前縱隔腫物胸腔鏡手術中國專家共識. 中國胸心血管外科臨床雜志, 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.	閔蘇, 何開華. 喉罩的臨床應用與管理專家共識. 臨床麻醉學雜志, 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.	唐煥雨, 黃桁, 姜凱元, 等. 胸腺上皮性腫瘤手術治療研究進展. 國際腫瘤學雜志, 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, 黃威. 劍突下拉鉤單孔胸腔鏡全胸腺切除術的技術要領—手術流程標準化. 中華胸心血管外科雜志, 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.	張程程, 吳亮, 范江. 治療重癥肌無力的新術式—劍突下雙拉鉤胸腔鏡下胸腺擴大切除術. 中國臨床新醫學, 2023, 16(6): 547-51.Zhang CC, Wu L, Fan J. 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.	劉星池, 許世廣, 徐惟, 等. 完全無管化達芬奇機器人縱隔腫瘤切除手術在快速康復外科中應用. 臨床軍醫雜志, 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, 馬潔, 陳召, 等. 喉罩與氣管插管麻醉下“三孔式”非肌無力胸腺瘤切除術的對比研究. 中國胸心血管外科臨床雜志, 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, Chief Editor. Anterior Mediastinal Mass. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2024 Apr 19].
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. Ak?ay 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. 趙金蘭, 陳蔚洋, 林琳, 等. 胸腔鏡劍突下單孔雙拉鉤與經劍突肋緣下三孔胸腺切除術治療胸腺瘤的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2025, 32(4): 482-487.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): 482-487.
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. 趙金蘭, 陳蔚洋, 何春梅, 等. “天平拉鉤抬高胸骨法”在經劍突下單孔胸腔鏡輔助前縱隔腫物切除術中的應用. 中國胸心血管外科臨床雜志, 2025, 32(3): 308-312.Zhao JL, Chen WY, He CM, et al, 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, Lu?eni? 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, 陳龍奇. 胸骨抬高經劍突下入路前縱隔腫物胸腔鏡手術中國專家共識. 中國胸心血管外科臨床雜志, 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. 閔蘇, 何開華. 喉罩的臨床應用與管理專家共識. 臨床麻醉學雜志, 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. 唐煥雨, 黃桁, 姜凱元, 等. 胸腺上皮性腫瘤手術治療研究進展. 國際腫瘤學雜志, 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, 黃威. 劍突下拉鉤單孔胸腔鏡全胸腺切除術的技術要領—手術流程標準化. 中華胸心血管外科雜志, 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. 張程程, 吳亮, 范江. 治療重癥肌無力的新術式—劍突下雙拉鉤胸腔鏡下胸腺擴大切除術. 中國臨床新醫學, 2023, 16(6): 547-51.Zhang CC, Wu L, Fan J. 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. 劉星池, 許世廣, 徐惟, 等. 完全無管化達芬奇機器人縱隔腫瘤切除手術在快速康復外科中應用. 臨床軍醫雜志, 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, 馬潔, 陳召, 等. 喉罩與氣管插管麻醉下“三孔式”非肌無力胸腺瘤切除術的對比研究. 中國胸心血管外科臨床雜志, 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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