Clinical Application Of Thoracoscopic Anterior Superior Mediastinal Tumor Resection Assisted By Suspension Hook And Subxiphoid Approach

Objective: The purpose of this study is to compare whether the method of thoracoscopic anterior upper mediastinal tumor resection assisted by the suspension hook raising the retrosternal space and subxiphoid approach has advantages over the thoracoscopic intercostal approach,and another aim is to study the learning curve of this operation,so as to provide a theoretical basis for the clinical promotion of this operation.Methods: A retrospective study was conducted to select 134 patients who were diagnosed as anterior and superior mediastinal tumors in the Thoracic Surgery of Guizhou Provincial People’s Hospital from January 2016 to August 2021,including 38 patients who underwent thoracoscopic anterior and superior mediastinal tumor resection through intercostal space,and 96 patients who underwent thoracoscopic anterior and superior mediastinal tumors assisted by suspension hook and subxiphoid approach.The operation time,blood loss,thoracic drainage tube extraction time,postoperative hospital day,incidence of postoperative complications,conversion to thoracotomy and other perioperative related statistical indicators were compared between the two groups to determine the safety of the operation;37 patients who underwent thoracoscopic resection of anterior mediastinal tumors with suspension hook under xiphoid process from July 2018 to September 2019 in the Thoracic Surgery of Guizhou Provincial People’s hospital were selected to explore the learning curve of this operation by the cumulative sum analysis(CUSUM)method.Results: The operation time,thoracic drainage tube extraction time and postoperative hospital stay in the subxiphoid group were shorter than those in the intercostal group.What’s more,the above indexes were statistically different(P<0.050).But there was no significant difference between the two groups in blood loss,conversion rate to thoracotomy and the incidence of postoperative complications(P>0.050).According to the study of learning curve,the minimum number of cases required to master this operation is about 13.The learning curve includes improvement stage of the operation(stage A)and the mastery stage(stage B).There is significant difference in the operation time between the two stages,but there is no significant difference in the blood loss,thoracic drainage tube extraction time,postoperative hospital day,postoperative complication rate and conversion rate to thoracotomy.Conclusion Thoracoscopic anterior and superior mediastinal tumors assisted by suspension hook and subxiphoid approach has a better surgical field of vision and can reduce the operation time.It is an operation with high safety,good curative effect and easy to grasp.