Ann Thorac Surg 2007;83:1984-1985
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
Frank C. Detterbeck, MD
Division of Thoracic Surgery, Yale University, FMB 128, 330 Cedar St, New Haven, CT 06520-8062
(Email: frank.detterbeck{at}yale.edu).
Mineo and colleagues [1] deserve credit for introducing and developing a hybrid approach that overcomes one of the primary limitations of video-assisted thoracic surgery (VATS), namely the inability to directly palpate the lung. The current article nicely describes their now extensive experience over 11 years with the transxiphoid approach and provides objective data of their results [1]. As their experience shows, it is a well-tolerated approach that results in minimal morbidity and rapid recovery.
It is surprising this technique has not been more widely adopted. Perhaps it is because many thoracic surgeons have not ventured very far beyond the simple wedge resection or pleural procedure. Perhaps it is because of the perception (generally well-deserved) that anything more than this requires a great deal of patience and is associated with a major learning curve. Perhaps it is because, in the case of metastasectomy, the temptation is too strong to only take out one or two lesions that one can see. However, multiple studies have shown that palpation still finds significantly more metastases than modern helical computed tomographic scanners. Perhaps it is because we have simply accepted that VATS approaches preclude any real palpation.
Perhaps it is more simply because it is always easier to stick to your own routine than to adopt something new. However, after 11 years of experience, it is not new or untested anymore. There is no real learning curve associated with this technique, and most thoracic surgeons should be quite comfortable with access to the substernal space. The pace of change in the modern world is rapid, and it challenges us to be creative. As Dr Robert Guyton admonished in his presidential address to The Society of Thoracic Surgeons just a few years ago, "Learn one new operation each year." This is an operation one can learn in a day. The data presented by Mineo and colleagues [1] should serve as a stimulus to thoracic surgeons who have not yet done so to add this procedure to their armamentarium.
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References
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- Mineo TC, Ambrogi V, Mineo D, Pompeo E. Transxiphoid hand-assisted videothoracoscopic surgery Ann Thorac Surg 2007;83:1978-1985.[Abstract/Free Full Text]
Related Article
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Transxiphoid Hand-Assisted Videothoracoscopic Surgery
- Tommaso Claudio Mineo, Vincenzo Ambrogi, Davide Mineo, and Eugenio Pompeo
Ann. Thorac. Surg. 2007 83: 1978-1984.
[Abstract]
[Full Text]
[PDF]
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