Transcervical Approach for Thoracic Operations

Marcin Zieliński, Wojciech Czajkowski, Sylweriusz Kosinski, Edward Fryzlewicz, Tomasz Nabialek, Juliusz Pankowski, Mariusz Rybak, Katarzyna Solarczyk-Bombik and Michal Wilkojc

Department of Thoracic Surgery, Pulmonary Hospital, Poland
Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Poland
Department of Pathology, Pulmonary Hospital, Poland
Department of Surgery, Pulmonary Hospital, Zakopane, Poland

^*Correspondance to: Marcin Zielinski 

 PDF  Full Text DOI: 10.25107/2474-1647.1447

Abstract

Aim: The aim of this study is to summarize our experience regarding thoracic operations performed through the use of the extended transcervical approach.Material and
Methods: Transcervical extended approach utilizes a collar incision in the neck with elevation of the sternal manubrium with a mechanical retractor. A bilateral visualization of the laryngeal recurrent and vagus nerves is usually performed to avoid injury of these structures. The procedures performed solely through the transcervical incision, or combined with videothoracoscopy (VATS) or/and subxiphoid incision were analyzed.Results: There were 1,984 transcervical operations from September 01, 2000 to September 30, 2016, including 405 transcervical-subxiphoid VATS maximal thymectomies for myasthenia gravis, thymomas or rethymectomies, 1,224 transcervical extended mediastinal lymphadenectomy (TEMLA) procedures for staging of non-small cell lung cancer (NSCLC), 332 resections of the mediastinal tumors and the mediastinal metastases (mostly from thyroid cancer), 17 pulmonary lobectomies combined with TEMLA for NSCLC and 6 attempts of closure of the right main bronchus postpneumonectomy fistula. There were 5/1984 (0.3%) patients who had to be converted because of technical difficulties, in no case there major bleeding, or other severe intraoperative complications or deaths. There were 14/1984 (0.7%) patients who required revision because of postoperative bleeding (through the original incision in all but one patient, who necessitated thoracotomy). There was morbidity of 6.2 % (128/1984) and mortality of 0.4% (7/1984).Conclusions: Transcervical extended approach with elevation of the sternal manubrium enables performance of various thoracic surgical procedures with minimal invasiveness, low mortality and morbidity and very high effectiveness.

Keywords

Thoracic operations; VATS; Thoracic surgery

Cite the article

Zielinski M, Czajkowski W, Kosinski S, Fryzlewicz E, Nabialek T, Pankowski J, et al. Transcervical Approach for Thoracic Operations. Clin Surg. 2017; 2: 1447.