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Ann Thorac Surg 2005;80:1982
© 2005 The Society of Thoracic Surgeons

Correspondence

Transxiphoid Hand-Assisted Thoracoscopic Surgery: An Approach Included in the Armamentarium

Tommaso C. Mineo, MD, Vincenzo Ambrogi, MD, Eugenio Pompeo, MD

Department of Thoracic Surgery, Policlinico Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy

(Email: ambrogi{at}med.uniroma2.it).

To the Editor:

With great interest we read the article by Detterbeck and Egan [1]. They advocated the usefulness of having one hand inside the thorax during a thoracoscopic procedure. It is nice to read reports of this approach from other authors. We believe this approach was first described by us as a "How to do it" article in The Annals of Thoracic Surgery in 1999 [2]. At that time we chose the term "transxiphoid" because resection of the xiphoid allowed easy insertion of the hand into the thorax. A few years later this approach was appropriately termed hand-assisted thoracoscopic surgery (HATS) [3].

Our series now includes 61 patients with lung metastases approached by transxiphoid access. Complications were minimal. As predicted, the transxiphoid approach proved safe and effective with advantages (ie, less postoperative pain, shorter in-hospital stays, easier patient and physician acceptance). Nonetheless, we also found a lower risk of recurrence with longer disease-free intervals based on the more accurate exploration.

Since the first presentation, we were quite confident that this approach would be adopted worldwide. Now others [2] congratulate Detterbeck and Egan [1] for renewing interest in transxiphoid HATS, which we had already included in our standard armamentarium.


   References
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 References
 

  1. Detterbeck FC, Egan TM. Thoracoscopy using a substernal handport for palpation Ann Thorac Surg 2004;78:1031-1036.[Abstract/Free Full Text]
  2. Mineo TC, Pompeo E, Ambrogi V, Pistolese C. Video-assisted approach for tranxiphoid bilateral pulmonary metastasectomy Ann Thorac Surg 1999;67:1808-1810.[Abstract/Free Full Text]
  3. Wright GM, Clarke CP, Paiva JM. Hand assisted thoracoscopy surgery Ann Thorac Surg 2003;75:1665-1667.[Abstract/Free Full Text]



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Ann. Thorac. Surg., November 1, 2005; 80(5): 1982 - 1983.
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