Modified subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance hook sternal elevation device in anterior mediastinal masses

OBJECTIVE: To explore the clinical value of the modified subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) with percutaneous suspension technique via "balance hook sternal elevation device" in anterior mediastinal masses. METHODS: Patients who underwent balance hook-assisted subxiphoid uniportal VATS for anterior mediastinal masses resection in the Department of Thoracic Surgery, Affiliated Hospital of Yangzhou University, between September 2025 and January 2026 were included. Clinical data and perioperative indicators were analyzed. RESULTS: A total of 16 patients were enrolled, comprising 6 males and 10 females, with ages ranging from 34 to 75 years. Tumor size ranged from 1.3 to 5.2 cm in the longest diameter. The operative time was 75-265 min, with an estimated blood loss of 10-100 mL. The Visual Analogue Scale (VAS) pain score was 4-7 on postoperative day 1, which decreased to 1-3 on postoperative day 3. Postoperative thoracic drainage duration was 2-7 days, and the postoperative hospital stay ranged from 3 to 9 days. Complete and safe resection of the tumor and thymus was successfully achieved in all patients. All patients recovered well postoperatively without significant complications. CONCLUSION: The modified "balance hook sternal elevation device" assisted technique effectively enlarges the retrosternal space, providing a satisfactory surgical field and adequate operating space for subxiphoid uniportal VATS. It ensures clear visualization of anterior mediastinal structures and facilitates the necessary extent of resection. The percutaneous suspension technique obviates the need for xiphoid resection, reduces sternal trauma, and further minimizes surgical injury. The combination of these two approaches holds potential clinical significance and application value in optimizing the efficacy and safety of minimally invasive anterior mediastinal surgery, minimizing surgical trauma and postoperative pain, and enhancing postoperative recovery for patients.