To systematically evaluate the safety and advantages of subxiphoid approach video-assisted thoracic surgery (SA-VATS) compared with intercostal approach video-assisted thoracic surgery (IA-VATS) fo...

Subxiphoid versus intercostal video-assisted thoracic surgery for lung resection: a meta-analysis

Objective
To discuss the feasibility and advantages of aberrant incision location of single–port video–assisted thoracoscopic surgery(VATS) in different gender when treating some lung diseases.


Methods
Retrospectively analyze the clinical data of these patients who were received lung partial resection from the same surgeon in the First Affiliated Hospital of Soochow University, the 100 Hospital of PLA, Wu Zhong People's Hospital from January 2012 to December 2014.Among the males, 57 were undertook a single–port VATS surgery through areola incision(Observation Group A), and the rest 114 were received conventional uniportal VATS surgery(Control Group A). Among the females, 15 were operated through the subxiphoid incision(Observation Group B) and 45 were received conventional one(Control Group B). The operation time, blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital stay, the Visual Analogue Scale(VAS) pain score of the 1st and 2nd postoperative day, the incision discomfort in the 30th and 90th postoperative day, and the incision satisfaction degree were evaluated.


Results
All the patients were underwent total VATS surgery successfully and no severe complications were observed.In males, there were no significant differences in operation time, blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital day and the VAS score of the 1st postoperative day(P>0.05). Compared to control group A, the VAS score of the 2nd postoperative day was lower(3.56±1.78 vs 4.14±1.62, P=0.035), the incision discomfort of 30th and 90th postoperative day was reduced (33(57.9%) vs 86(75.4%), P=0.019; 29(50.9%) vs 76(66.7%), P=0.046) and the incision satisfaction degree was significantly improved(45(79.0%) vs 61(53.5%), P=0.001). In females, there were no statistical differences in intraoperative blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital day and the incision satisfaction degree(P>0.05). Compared to control group B, the operation time was obviously prolonged(57.67±5.72 vs 42.91±7.82, P=0.000), the VAS score of the 1st and 2nd postoperative day was significantly lower(2.13±1.06 vs 3.84±1.69, P=0.001; 2.60±1.24 vs 4.18±1.56, P=0.001) and the incision discomfort in 30th and 90th postoperative day was reduced(4(26.7%) vs 34(75.6%), P=0.001; 4(26.7%) vs 28(62.2%), P=0.017).


Conclusion
In single–port VATS surgery for some pulmonary diseases, we choose"individualized"incision location––trans–areola incision in males and subxiphoid incision in females––according to different gender and varieties of diseases, which was considered to raise incision satisfaction degree in males and reduce postoperative pain in females, it warrants further clinical practice.


Key words: 
Lung diseases; Thoracoscopes; Pain; Areola; Subxiphoid

[Single-port VATS resection for some pulmonary diseases:strategies of the incision location in different gender].

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[Single-port VATS resection for some pulmonary diseases:strategies of the incision location in different gender].