• News

A 20-year-old Girl Was Treated with Double Hook of the Sternum under Xiphoid Process by Thoracic Surgery Department at Shanghai General Hospital

The link of original Chinese report: https://wap.xinmin.cn/content/32121247.html

A 20-year-old girl from Yunnan came to the clinic of Director Fan Jiang of Thoracic Surgery Department at Shanghai General Hospital with severe chest pain. A chest CT showed a mediastinal mass of about 30 cm in diameter, which was highly suspected to be a "teratoma". Although the teratoma was not malignant, it is large, squeezing all of the girl's chest space, causing her unbearable pain - chest tightness, suffocation and coughing. Surgery is definitely necessary, but how to do it makes the family and doctors torn ......

Minimally invasive solution for 30 cm teratoma, patient's father cries with joy

Wang Xing,the attending physician of Thoracic Surgery Department at Shanghai General Hospital told reporters that the patient had a large mass with little space, "If it breaks, it may not be possible to achieve a radical cure, and in case of a recurrence, it will be more troublesome." However, the girl's father repeatedly requested the doctor to use a minimally invasive surgery, and even had "obsessions" about it: "She is still small, and a large incision on her chest may be unacceptable." Finally, after repeated discussions, Dr. Fan Jiang decided to lead his team to challenge the difficulties by using his patented technique - "double hook of the sternum under xiphoid process" and removing the tumor under the thoracoscope.

Where is the xiphoid? In the middle of the chest, there is a vertically downward bone like a sword, which is the sternum. The "tip" of the sword is a piece of cartilage, which is the "xiphoid".

Open the xiphoid process and reveal a gap of only about 4 cm that can enter the chest. This channel is very narrow, and only by lifting the sternum with the help of the "artifact" of "double hook", can the gap be expanded to 45 cm, up to 10 cm, and the field of vision of the mediastinum be fully exposed, which is also the core reason for minimally invasive surgery. The team completely removed the mediastinal mass and capsule, and thoroughly cleaned the anterior pericardium and the interior of bilateral phrenic nerves. The operation was a success. The patient and his father cried with joy. Now the family has finally lived a normal life.

Independently designed surgical instruments suitable for Chinese people

The "double hook system", to put it simply, is a pair of metal hooks, allowing patients who could only undergo traditional thoracotomy in the past to find another possibility and extending the indications for minimally invasive thoracoscopic surgery. But this is not an ordinary hook. Moreover, even with the hooks, Moreover, even with hooks, unskilled doctors dare not use them at all. This is because in the thoracic cavity, the large blood vessels and heart are buried in it, forming a "minefield" that cannot be touched by the scalpel, and once the large blood vessels or heart are injured, the consequences are unimaginable. Fan Jiang independently designed the "suspension double hook system", which was first used by him to treat thymic tumors. He was the first person to carry out the "subxiphoid double hook total thymectomy" in China.

Dr. Fan Jiang told the reporter that in 2015, he watched a surgery video of a professor in Poland, which showed a double hook thymectomy and impressed him a lot. At that time, he was a doctor at Shanghai Pulmonary Hospital. Previously, in China, the sternum was usually split in the middle or the lateral approach from the chest cavity, but no one had ever thought of lifting the sternum up. For several months, he worked on this procedure.

At first, he just wanted to "bring" it from abroad, but after contacting foreign manufacturers, he found that the device was not mass-produced. So he tried to contact a variety of domestic medical equipment manufacturers and wanted to make the double hook by himself. "In the end, how can I pull it up? I thought a lot of ways, either with steel wire or with hinges. Some of the designs were too complex and even not like surgical instruments. After countless attempts, we finally chose a commonly used orthopedic instruments, erected it and pull hooks combined together, and finally made it. After tossing it back and forth for seven or eight months, it was finally applied to surgery in 2016.

Fan Jiang said the incision is another problem. The Asian body is not as wide as that of Europeans. If the transverse incision is used, the angle is too small for a surgery, thus the improvement is imperative. Left incision, chest top incision and lower cardiac incision... After 20 or 30 simple operations, he found the "best way to open" the incision and explored the indications for extended thoracoscopic surgery with the aid of "double hooks", and his footprint began to spread to many cities in China ......

From difficult promotion to "good helper" of surgery

Fan Jiang mentioned that it was a difficult process to promote the procedure in China at the beginning. The hook was more than one meter long and each time, he and a doctor who was a trainee had to carry it to the airport like a renovator. Later, they made several improvements to the design of the pull hook and finally packed it all into one box. Today, the pull hook system has become a "good assistant" in many hospitals for thymic surgery, and he has received more and more positive feedback. For example, Professor Peter Litch, president of the European Society of Thoracic Surgeons, asked him for a video of the surgery, saying that he wanted to show his European colleagues what level of surgery China has reached. Now, the team led by Dr. Fan Jiang has been able to perform thymus surgery through the double pull hooks under the xiphoid process. Basically, 90% of the thymic surgeries are performed with this pair of double hooks.

For example, myasthenia gravis is an autoimmune disease caused by transmission dysfunction at the neuromuscular junction. Its clinical manifestations are partial or systemic skeletal muscle weakness and fatigue (eyelid ptosis, blurred vision, diplopia, strabismus, etc.). Serious symptoms will make the ventilator weak, lead to dyspnea, and even endanger life. In myasthenia gravis patients, 65% - 80% had thymic hyperplasia and 10% - 20% had thymoma. Thymoma with myasthenia gravis requires the most extended surgical resection, and the choice of surgical approach is the focus of debate in the industry. However, with the introduction of "double pull hook total thymectomy ", there is a new way to think about this problem.

Correspondent:Yan Zuo, Xinminwanbao

Find a Doctor