Thoracoscopic lateral intercostal approaches are commonly used for minimally invasive resection of mediastinal tumors in children. In adults, the subxiphoid approach has gained popularity because of reduced intercostal neuralgia and improved cosmetic outcomes; however, its application in pediatric patients remains limited. A 7-year-old boy presented with chest pain and was found to have a 32-mm unilocular cystic tumor in the middle mediastinum. Thoracoscopic reduced-port surgery was performed using a subxiphoid uniportal approach with an additional port placed in the left fifth intercostal space. A 25-mm subxiphoid incision was created, and the retrosternal space was developed with sternal elevation using a retractor system. A chest drain was placed through the intercostal port postoperatively. Bidirectional visualization from the subxiphoid and lateral intercostal ports enabled safe dissection and removal of the tumor, which was surrounded by major vascular structures. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. The combination of a subxiphoid port and a lateral intercostal port seems to be a feasible option for the resection of mediastinal tumors. • Subxiphoid approach applied to a pediatric middle mediastinal tumor. • Reduced-port technique combining uniportal and intercostal access. • Adequate exposure achieved without CO 2 insufflation. • Safe resection of tumor adjacent to major vessels. • Favorable postoperative course without chest wall deformity.
Miyake et al. (Thu,) studied this question.