Subxiphoid uniportal VATS (SUVATS) is rapidly changing how clinicians manage blunt thoracic trauma. While surgeons historically relied on median sternotomy for mediastinal hematomas, this minimally invasive technique offers a superior alternative. Recently, a case report highlighted how SUVATS successfully treated extrapericardial tamponade in a 65-year-old patient.

The patient sustained a sternal fracture and a retrosternal hematoma after a 4-meter fall. Although he appeared stable initially, his hemodynamic status eventually deteriorated. Consequently, an echocardiogram revealed right ventricular compression. This finding confirmed the presence of extrapericardial tamponade. Therefore, the medical team chose SUVATS for urgent surgical intervention.

Advantages of Subxiphoid Uniportal VATS in Trauma

Using subxiphoid uniportal VATS provides several distinct advantages for trauma patients. First, the technique allows for excellent exposure of the anterior mediastinal space. Moreover, it assists in complex procedures like sternal fixation. Second, because the incision is subxiphoid, it completely avoids the intercostal nerves. As a result, patients experience significantly less postoperative pain. Furthermore, this approach reduces the risk of respiratory complications.

Additionally, the surgical team successfully evacuated the hematoma and achieved hemostasis. Specifically, the team extubated the patient on the same day of the surgery. He subsequently left the hospital without any complications. In conclusion, SUVATS is a safe and effective option for selected trauma cases. It provides a less invasive path to recovery for patients who do not have major vascular injuries.

FAQ

What is extrapericardial tamponade?

Extrapericardial tamponade occurs when a hematoma outside the pericardial sac, often in the anterior mediastinum, compresses the heart and impairs its function.

Why is SUVATS preferred over sternotomy?

Unlike a median sternotomy, SUVATS is minimally invasive, avoids intercostal nerve damage, reduces postoperative pain, and speeds up patient recovery.

Can SUVATS be used for all chest trauma cases?

SUVATS is suitable for selected cases where there is no major vascular injury, providing effective hematoma evacuation and excellent visualization.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here. Refer to the latest local and national guidelines for clinical practice.

References

Lee N et al. Extrapericardial tamponade following blunt chest trauma treated with subxiphoid uniportal video-assisted thoracoscopic surgery: a case report. J Cardiothorac Surg. 2026 Feb 06. doi: 10.1186/s13019-026-03871-x. PMID: 41652439.

Yang X, Wang L, Zhang C, et al. The Feasibility and Advantages of Subxiphoid Uniportal Video-Assisted Thoracoscopic Surgery in Pulmonary Lobectomy. World J Surg. 2019;43(8):2011-2019.

Serna-Gallegos D, Enriquez C, McKenna RJ Jr. Subxiphoid uniportal VATS: technical nuances and future directions. J Vis Surg. 2017;3:163.