Subxiphoid video-assisted thoracoscopic surgery versus standard video-assisted thoracoscopic surgery for anatomic pulmonary lobectomy Q1 Q15 Yu-Yun Nan, a Yen Chu, a Yi-Cheng Wu, a Chien-Ying Liu, b Yin-Kai Chao, a Ching-Yang Wu, a Yun-Hen Liu, c, * and Hui-Ping Liu a Q2 a Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan b Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan c Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Q3 article info Article history: Received 2 April 2015 Received in revised form 10 June 2015 Accepted 13 August 2015 Available online xxx Keyword: Subxiphoid lobectomy abstract Background: A subxiphoid surgical approach to thoracic cavity operations has potential advantages such as preventing injuries to intercostal nerves and vessels due to the bypass of the intercostal space during thoracic surgery. The aim of this study was to compare the feasibility and efficacy of the subxiphoid and standard transthoracic approaches for anatomic pulmonary lobectomy in a canine model. Methods: Nineteen dogs were assigned for pulmonary lobectomy using either the subxiphoid (n ¼ 10) or standard transthoracic approaches (n ¼ 9). Each group underwent thoracic exploration and anatomic pulmonary lobectomy. Subxiphoid thoracoscopy was performed with a flexible bronchoscope via a 3-cm incision over the xiphoid process. In the conventional thoracoscopy group, approach to the thoracic cavity was obtained through a 3-cm incision over the seventh intercostal space. Physiological parameters (respiratory rate and body temperature) and blood samples (white blood cell counts and arterial blood gases) were collected during the preoperative and postoperative periods. Surgical outcomes data (oper- ating time, operative complications, and body weight gain) were also collected and compared between the groups. The animals were sacrificed 14 d after surgery for necropsy evaluations. Results: Anatomic pulmonary lobectomy was successfully performed without intra- operative and postoperative complications in all animals. There were no significant dif- ferences in the mean operating times or weight gain after surgery between the subxiphoid and the standard transthoracic approach groups. In terms of physiological and pulmonary parameters, there were no observed differences between the two surgical groups for res- piratory rate, body temperature, white blood cell counts, and arterial blood gases at any time during the study. Necropsy confirmed the success of lobectomy without complication in all studied animals. Conclusions: This study demonstrated that the subxiphoid approach was comparable with the standard transthoracic approach for anatomic pulmonary lobectomy, in terms of feasibility and effectiveness. ª 2015 Elsevier Inc. All rights reserved. * Corresponding author. Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fushing Street, Gueishan Shiang, Taoyuan, Taiwan 333, ROC. Tel.: þ886 3 3281200x2118; fax: þ886 3 3285818. Q4 E-mail address: zebraairmail@gmail.com (Y.-H. Liu). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research xxx (2015) 1 e8 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.08.012 5.4.0 DTD  YJSRE13490_proof  1 September 2015  6:41 am  ce 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130