Subxiphoid uniportal video-assisted thoracoscopic one-stage bilateral pulmonary resection via the balance-shaped sternal elevation device for percutaneous suspension technique: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xingbao ^1,2 , JIN Xiaohan ³ , DENG Zhiqiang ² , LIN Pei ¹ , WANG Jia ¹ , SHU Yong ⁴ , HE Chaokun ⁵ , LAI Xiaoqin ¹ , LIN Feng ^1,2 , CHEN Longqi ^1,2 ,  TIAN Dong ^1,2

1. Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, P. R. China;
4. Department of Surgery, Jingyang District Hospital of Traditional Chinese Medicine (People’s Hospital), Deyang, 618000, Sichuan, P. R. China;
5. Department of Thoracic Surgery, Langzhong People’s Hospital, Nanchong, 637400, Sichuan, P. R. China;

Corresponding?author：

TIAN Dong, Email: 22tiandong@163.com

Keywords：

Balance-shaped sternal elevation device for percutaneous suspension technique; subxiphoid approach; uniportal video-assisted thoracoscopic surgery; bilateral multiple pulmonary nodules; one-stage pulmonary resection

DOI：

10.7507/1007-4848.202605059

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

For bilateral multiple pulmonary nodules, two-stage surgery imposes a significant physical and psychological burden on patients due to repeated anesthesia and surgical trauma, making one-stage bilateral surgery a theoretically more ideal treatment strategy. However, conventional one-stage bilateral surgery via the intercostal approach often requires intraoperative repositioning, resulting in greater trauma and prolonged operative time, while the subxiphoid approach faces challenges including insufficient surgical field exposure and severely limited operative space, posing high surgical risks during anatomical lobectomy. This article reports a 54-year-old male patient with bilateral multiple pulmonary nodules, who required a simultaneous left upper lobe wedge resection and a right middle lobectomy. Accordingly, our team successfully performed subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for one-stage bilateral pulmonary resection. By innovatively incorporating the balance-shaped sternal elevation device for percutaneous suspension technique into subxiphoid uniportal VATS, the operative space was significantly expanded and surgical field exposure was markedly optimized, reducing the risk and difficulty of pulmonary resection via the subxiphoid approach. The patient recovered uneventfully, and short-term follow-up revealed no abnormalities.

1.	Wang C, Gao J, Wang R, et al. Electromagnetic navigation bronchoscopy for localization of bilateral multiple pulmonary nodules: a comparative evaluation of safety and efficacy[J]. Transl Lung Cancer Res, 2025, 14(12): 5347-5356.
2.	Han Y, Xiao F, Ma Q, et al. One-stage versus two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a propensity score-matched analysis[J]. World J Surg Oncol, 2025, 23(1): 18.
3.	Eduardo Noleto Da Nobrega Oliveira R, Franceschini Machado G, Cabianca Moriguchi Caetano Salvador I, et al. One-stage vs. two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a systematic review and meta-analysis[J/OL]. Front Surg, 2025, 12: 1755084. DOI: 10.3389/fsurg.2025.1755084.
4.	張書新, 趙亞超, 周愛國, 等. 同期雙側胸腔鏡手術在雙肺多發肺結節外科治療中的應用價值[J]. 南方醫科大學學報, 2023, 43(7): 1254-1258.Zhang SX, Zhao YC, Zhou AG, et al. Application value of synchronous bilateral thoracoscopic surgery in surgical treatment of bilateral multiple pulmonary nodules[J]. J South Med Univ, 2023, 43(7): 1254-1258.
5.	肖寒松, 黃春. 同期雙側單孔胸腔鏡下亞肺葉切除在雙肺多發結節治療中的安全性分析[J]. 重慶醫學, 2025, 54(8): 1899-1903.Xiao HS, Huang C. Safety analysis of synchronous bilateral single-port thoracoscopic sublobar resection in treatment of bilateral multiple pulmonary nodules[J]. Chongqing Med, 2025, 54(8): 1899-1903.
6.	Rojas D, Iquille J, De Latour BR, et al. Surgical outcomes of subxiphoid thoracoscopic complex basilar sublobar resection versus lower lobectomy: a single-centre retrospective analysis[J]. Eur J Cardiothorac Surg, 2026, 68(1).
7.	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[J]. 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 "sternum elevation with balance retractor" in subxiphoid single-port thoracoscopic-assisted resection of anterior mediastinal masses[J]. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
8.	Jin XH, Yan HJ, Liu BS, et al. Percutaneous suspension technique for thymectomy and superior vena cava replacement without sternotomy in a patient with thymic carcinoma: case report[J]. JTCVS Tech, 2025: 102132.
9.	田東, 鄧志強, 林浩楠, 等. 經皮懸吊拉鉤輔助漏斗胸矯治術的臨床應用及技術優勢[J/OL]. 中國胸心血管外科臨床雜志, 2025. DOI: 10.7507/1007-4848.202508035.Tian D, Deng ZQ, Lin HN, et al. Clinical application and technical advantages of percutaneous suspension retractor-assisted pectus excavatum correction[J/OL]. Chin J Clin Thorac Cardiovasc Surg, 2025. DOI: 10.7507/1007-4848.202508035.
10.	Tian D, Zhao JS, Yan HJ, et al. A novel technique for localizing pulmonary nodules through percutaneous catheter puncture[J]. J Thorac Dis, 2025, 17(6): 3658-3666.
11.	Hsueh KY, Tang EK, Wu FZ, et al. Comparison between one-stage and two-stage CT-guided localization of lung nodules with surgical resection: a single medical center experience[J]. J Cardiothorac Surg, 2024, 19(1): 304.
12.	Cheng M, Ding R, Wang S. Diagnosis and treatment of high-risk bilateral lung ground-glass opacity nodules[J]. Asian J Surg, 2024, 47(7): 2969-2974.
13.	似繼承, 顧紅蒼, 王曉航. 劍突下入路與肋間入路胸腔鏡下前縱隔腫瘤切除的對比研究[J]. 臨床肺科雜志, 2025, 30(9): 1317-1320.Si JC, Gu HC, Wang XH. Comparative study of subxiphoid and intercostal approaches for thoracoscopic resection of anterior mediastinal tumors[J]. J Clin Pulm Med, 2025, 30(9): 1317-1320.
14.	曾偉強, 黨海麗, 茍云久. 經劍突下與經肋間入路胸腔鏡手術治療前縱隔腫瘤圍術期結果的系統評價與Meta分析[J]. 中國胸心血管外科臨床雜志, 2024, 31(10): 1514-1521.Zeng WQ, Dang HL, Gou YJ. Perioperative outcomes of subxiphoid versus intercostal approach thoracoscopic surgery for anterior mediastinal tumors: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1514-1521.
15.	鄺光志, 楊倩, 王傳才, 等. 經劍突下入路和經肋間入路單孔胸腔鏡胸部手術的臨床效果比較[J]. 中國醫學創新, 2025, 22(23): 68-71.Kuang GZ, Yang Q, Wang CC, et al. Comparison of clinical effects between subxiphoid and intercostal approaches in uniportal thoracoscopic thoracic surgery[J]. China Med Innov, 2025, 22(23): 68-71.
16.	Kawaguchi T, Kaneda S, Ito D, et al. Subxiphoid single-port robot-assisted bilateral lung resection[J]. JTCVS Tech, 2025, 34: 226-229.

1. Wang C, Gao J, Wang R, et al. Electromagnetic navigation bronchoscopy for localization of bilateral multiple pulmonary nodules: a comparative evaluation of safety and efficacy[J]. Transl Lung Cancer Res, 2025, 14(12): 5347-5356.
2. Han Y, Xiao F, Ma Q, et al. One-stage versus two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a propensity score-matched analysis[J]. World J Surg Oncol, 2025, 23(1): 18.
3. Eduardo Noleto Da Nobrega Oliveira R, Franceschini Machado G, Cabianca Moriguchi Caetano Salvador I, et al. One-stage vs. two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a systematic review and meta-analysis[J/OL]. Front Surg, 2025, 12: 1755084. DOI: 10.3389/fsurg.2025.1755084.
4. 張書新, 趙亞超, 周愛國, 等. 同期雙側胸腔鏡手術在雙肺多發肺結節外科治療中的應用價值[J]. 南方醫科大學學報, 2023, 43(7): 1254-1258.Zhang SX, Zhao YC, Zhou AG, et al. Application value of synchronous bilateral thoracoscopic surgery in surgical treatment of bilateral multiple pulmonary nodules[J]. J South Med Univ, 2023, 43(7): 1254-1258.
5. 肖寒松, 黃春. 同期雙側單孔胸腔鏡下亞肺葉切除在雙肺多發結節治療中的安全性分析[J]. 重慶醫學, 2025, 54(8): 1899-1903.Xiao HS, Huang C. Safety analysis of synchronous bilateral single-port thoracoscopic sublobar resection in treatment of bilateral multiple pulmonary nodules[J]. Chongqing Med, 2025, 54(8): 1899-1903.
6. Rojas D, Iquille J, De Latour BR, et al. Surgical outcomes of subxiphoid thoracoscopic complex basilar sublobar resection versus lower lobectomy: a single-centre retrospective analysis[J]. Eur J Cardiothorac Surg, 2026, 68(1).
7. 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[J]. 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 "sternum elevation with balance retractor" in subxiphoid single-port thoracoscopic-assisted resection of anterior mediastinal masses[J]. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 308-312.
8. Jin XH, Yan HJ, Liu BS, et al. Percutaneous suspension technique for thymectomy and superior vena cava replacement without sternotomy in a patient with thymic carcinoma: case report[J]. JTCVS Tech, 2025: 102132.
9. 田東, 鄧志強, 林浩楠, 等. 經皮懸吊拉鉤輔助漏斗胸矯治術的臨床應用及技術優勢[J/OL]. 中國胸心血管外科臨床雜志, 2025. DOI: 10.7507/1007-4848.202508035.Tian D, Deng ZQ, Lin HN, et al. Clinical application and technical advantages of percutaneous suspension retractor-assisted pectus excavatum correction[J/OL]. Chin J Clin Thorac Cardiovasc Surg, 2025. DOI: 10.7507/1007-4848.202508035.
10. Tian D, Zhao JS, Yan HJ, et al. A novel technique for localizing pulmonary nodules through percutaneous catheter puncture[J]. J Thorac Dis, 2025, 17(6): 3658-3666.
11. Hsueh KY, Tang EK, Wu FZ, et al. Comparison between one-stage and two-stage CT-guided localization of lung nodules with surgical resection: a single medical center experience[J]. J Cardiothorac Surg, 2024, 19(1): 304.
12. Cheng M, Ding R, Wang S. Diagnosis and treatment of high-risk bilateral lung ground-glass opacity nodules[J]. Asian J Surg, 2024, 47(7): 2969-2974.
13. 似繼承, 顧紅蒼, 王曉航. 劍突下入路與肋間入路胸腔鏡下前縱隔腫瘤切除的對比研究[J]. 臨床肺科雜志, 2025, 30(9): 1317-1320.Si JC, Gu HC, Wang XH. Comparative study of subxiphoid and intercostal approaches for thoracoscopic resection of anterior mediastinal tumors[J]. J Clin Pulm Med, 2025, 30(9): 1317-1320.
14. 曾偉強, 黨海麗, 茍云久. 經劍突下與經肋間入路胸腔鏡手術治療前縱隔腫瘤圍術期結果的系統評價與Meta分析[J]. 中國胸心血管外科臨床雜志, 2024, 31(10): 1514-1521.Zeng WQ, Dang HL, Gou YJ. Perioperative outcomes of subxiphoid versus intercostal approach thoracoscopic surgery for anterior mediastinal tumors: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1514-1521.
15. 鄺光志, 楊倩, 王傳才, 等. 經劍突下入路和經肋間入路單孔胸腔鏡胸部手術的臨床效果比較[J]. 中國醫學創新, 2025, 22(23): 68-71.Kuang GZ, Yang Q, Wang CC, et al. Comparison of clinical effects between subxiphoid and intercostal approaches in uniportal thoracoscopic thoracic surgery[J]. China Med Innov, 2025, 22(23): 68-71.
16. Kawaguchi T, Kaneda S, Ito D, et al. Subxiphoid single-port robot-assisted bilateral lung resection[J]. JTCVS Tech, 2025, 34: 226-229.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesSubxiphoid uniportal video-assisted thoracoscopic one-stage bilateral pulmonary resection via the balance-shaped sternal elevation device for percutaneous suspension technique: A case report

Abstract Full text Figures/Tables Video References Cited by

Format

Content