Retrospective Study Of Subxiphoid Approach And Lateral Thoracic Approach In Minimally Invasive Surgery For Thymic Diseases

Objective: This study retrospectively analyzed the clinical data of patients undergoing thoracoscopic thymectomy through the subxiphoid approach("three-hole method")and through the lateral thoracic approach,and observed the perioperative indicators of the two groups of patients.The clinical application value of the subxiphoid approach is discussed.At the same time,the concept of "Mediastinal Index" was established to explore whether this index has guiding significance for the choice of surgical approach.Method: A retrospective analysis of 87 patients underwent thoracoscopic thymectomy in our hospital’s thoracic surgery from January 2018 to November 2020,including 6 patients with myasthenia gravis(myasthenia gravis,MG).According to different surgical methods,all patients were divided into 2 groups,the subxiphoid approach group(n=41)and the lateral thoracic approach group(n=46).Collected the clinical data of the patients,on the operation time,intraoperative blood loss,postoperative fasting time,observation time in the ICU,indwelling catheter time,indwelling thoracic drainage periods,and whether additional analgesia is needed after surgery,duration of postoperative hospital stay,postoperative complications,hospitalization costs,pathological results,"Mediastinal Index" and other data were statistically analyzed to compare whether there are statistical differences in the clinical results of the two surgical approaches.Result: A total of 87 patients were included in the study.The operations were performed as planned,without conversion to thoracotomy.Among them,41 cases underwent thoracoscopic thymectomy through the subxiphoid approach and 46 cases underwent thoracoscopic thymectomy through the lateral thoracic approach.The subxiphoid approach group is lower than the lateral thoracic approach group in terms of operation time(99.12±19.57 min vs.112.17±28.12 min,p=0.015),intraoperative blood loss[20.00(20.00,50.00)ml vs.45.00(20.00,50.00)ml,p=0.039],indwelling catheter time[32.30(23.26,33.81)h vs.36.84(25.40,41.07)h,p=0.043],indwelling thoracic drainage periods[26.88(20.20,45.87)h vs.45.99(39.34,65.71)h,p=0.001],and duration of postoperative hospital stay[4.00(3.50,6.00)d vs.5.00(4.00,6.00)d,p=0.021].However,the postoperative complications[27(71.1%)vs.11(28.9%),p<0.001],especially bilateral pleural effusion after extubation [11(84.6%)vs.2(15.4%),p=0.003],and reinsert the tube after extubation [21(77.8%)vs.6(22.2%),p<0.001] were higher than those in the lateral thoracic approach group.And the difference was statistically significant.There was no statistically significant difference between the two groups in general data,"Mediastinal Index",and other perioperative and complications data.Conclusion: For patients with thymic diseases and suitable for minimally invasive surgery,the subxiphoid approach is superior to the lateral thoracic approach in terms of operation time,intraoperative blood loss,indwelling catheter time,indwelling thoracic drainage periods,and duration of postoperative hospital stay.It is a recommended surgical method.The "Mediastinal Index" may not be able to guide the choice of surgical approach.