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08-04-2024 | Thymectomy

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery

Authors: Maodan Chen, Yang Huang, Juyi Hu, Longfei Jia, Yuanzhou Wu, Jing Feng, Fuwei Zhang, Jian Tong, Qunqing Chen, Hui Li

Published in: Surgical Endoscopy | Issue 5/2024

Abstract

Background

Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury.

Methods

We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups.

Results

Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001–1.186), P = 0.048 by binary logistic regression analysis.

Conclusions

We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients’ anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

Graphical abstract

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Title: Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery
Authors: Maodan Chen
Yang Huang
Juyi Hu
Longfei Jia
Yuanzhou Wu
Jing Feng
Fuwei Zhang
Jian Tong
Qunqing Chen
Hui Li
Publication date: 08-04-2024
Publisher: Springer US
Keywords: Thymectomy
Thymectomy
Incision
Published in: Surgical Endoscopy / Issue 5/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10789-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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