Subxiphoid video-assisted major lung resections: the skeptic’s speech

The subxiphoid approach as an access to the chest has been initially pioneered by Asian surgeons in order to perform thymectomy (1) and, more lately, major lung resections (2). In a recent paper, published by the European Journal of Cardio-thoracic Surgery, Hernandez-Arenas and coworkers, from the Shanghai Pulmonary Hospital, describe their initial experience with uniportal, video-assisted, subxiphoid approach to major lung resection (3). The authors retrospectively report a remarkable series of 153 consecutive patients who had undergone lobectomy and segmentectomy through this completely new, (not-so) “extrathoracic” approach. The results were very remarkable, with the majority of patients [93] being discharged from the hospital within 4 days after the operation. Complications and conversion profile was similar to standard approach. An evaluation of postoperative pain is reported, and pain perception seems acceptable except for the postoperative day 1 (At that time more than 90% of patients complained pain ranging from moderate to severe).