Summary and treatment of special situations in subxiphoid uniportal VATS surgery

Jichen Qu, Xin Huang, Deping Zhao, Jian Chen, G. Jiang, Lei Jiang
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Abstract

Objective To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. Methods In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. Results Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known. Key words: Thoracoscopy; Uniportal; Subxiphoid; Operative complications
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剑突下单门VATS手术特殊情况的总结与处理
目的探讨剑突下单门静脉导管内固定术的特殊情况,总结治疗策略。方法于2014年9月行剑突下单门静脉血管辅助手术。截至目前,我课课组已完成剑突下单门VATS手术300余例,其中剑突下单门VATS节段切除术242例,剑突下单门VATS纵隔肿瘤切除术22例。术中遇到心脏骤停、心包填塞、不明原因静脉损伤、严重心律失常、肺段定位困难、小结节定位困难等特殊情况。结果部分患者因术中出现严重心律失常、心脏问题、术中出血等紧急情况而改变手术方式。术后并发症主要有开胸止血、术后持续漏气、肺血肿、心律失常,无围手术期死亡。结论剑突下单门静脉内固定术是胸部微创技术的重要体现。选择合适的病例,掌握胸腔镜技术和特殊的手术技术是安全可行的。在剑突下单门静脉血管辅助手术中的特殊情况应了解。关键词:胸腔镜;Uniportal;Subxiphoid;手术并发症
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