Comparison of subxiphoid and lateral intercostal approach in anterior mediastinal pathologies.

Abstract

Background: The anterior mediastinum is the compartment where mediastinal lesions are most frequently seen. Both subxiphoid approaches (SVATS) and lateral intercostal approaches (LVATS) are used in anterior mediastinal lesions. In this study, we aimed to compare the outcomes and advantages of SVATS and LVATS.

Methods: Between January 2013 and December 2024, the patients who underwent minimally invasive surgery for anterior mediastinal lesions were retrospectively analyzed. The study's main objectives were the characteristics of the patients, operation time, length of hospital stay, drain type, drain duration, postoperative complications, and visual analogue scale (VAS) analysis.

Results: A total of 79 patients were included in this study. Of these, 58.2% (n=46) cases were operated via LVATS and 41.8% (n=33) via SVATS. No significant difference was found in operation time, length of hospital stay, and complication. The most common postoperative complication was serous wound drainage. In one patient in the LVATS group, hence hemothorax was seen on postoperative day 1, revision surgery had to be done. Drain removal time was shorter in the subxiphoid group, but no statistical difference was found (p=0.059). In patients whose drain removal time was under 2 days, the length of hospital stay was also significantly shorter (p<0.001). The mean VAS was 2.24±1.25 in the SVATS group and 4.22±1.31 in the LVATS group.

Conclusion: This study shows that SVATS significantly affected VAS. However, no süperiority was observed between SVATS and LVATS regarding operation time, length of hospital stay, and perioperative complications. Therefore, SVATS may be preferred over LVATS in anterior mediastinal lesions and may improve patients' quality of life with less pain.