Subxiphoid uniportal lobectomy

Video-assisted thoracic surgery (VATS) surgery has seen an evolution from multiple ports to uniportal and finally subxiphoid uniportal recently. In traditional VATS surgery, the instruments and the thoracoscope enter the thoracic cavity through two to four operating ports on the lateral chest wall, which can cause chronic pain and chest wall numbness. However single-portal VATS surgery could potentially cause similar problems as the port is placed in between the ribs. In March 2015 Liu et al. reported a VATS bilateral pulmonary metastasectomy and right middle lobectomy via a subxiphoid uniportal technique. The advantage of the uniportal subxiphoid approach is the ability to use different size of instruments and freedom of movement as there is no limitation by the ribs. Post-operative pain typically experienced due to bruising of the intercostal nerves is also avoided in this approach. Shanghai Pulmonary hospital has taken VATS surgery to the next level with subxiphoid uniportal VATS (SVATS) lung resection, whereby this method is performed in large volumes of cases. Here we describe our experience of a uniportal subxiphoid VATS right middle lobectomy using the Shanghai technique, the first in the UK. A uniportal sub-xiphoid lobectomy was performed on a 62-year-old lifelong smoker male patient with a histological diagnosis of right middle lobe adenocarcinoma, measuring 1.5 cm and radiological staging of T1aN0M0. We have been performing microlobectomies in our institution (with the utility port placed in the subxiphoid region) which is technically similar to this approach. This is the first subxiphoid uniportal lobectomy performed in the UK. The operation was done successfully and the patient was discharged home 2 days later without any complications.