文章旨在研究外科学课程思政的素材选择和教学方式,以构建相对固定的外科学课程思政教学体系.让教师做到外科知识传授与价值引领同行并重.最终,把学生培养成医德高尚,医术精湛的医生.

There are many methods of minimally invasive surgery for anterior mediastinal diseases. However, the subxiphoid approach thoracoscopic surgery is considered to be the best. For beginners, there are more likely to damage diaphragm and create operative space difficult due to the wrong direction of trocars in the ports of costal arch. In order to let the beginners master this technology efficiently, we improve the technology and elaborate the technology combined with the experience and a case.

We read with great interest the article by Xu and Zhang,1Xu H. Zhang L. A novel and simple method for establishing the subxiphoid approach during thoracoscopic thymectomy.Ann Thorac Surg. 2019; 107: e369-e370Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar “A novel and simple method for establishing the subxiphoid approach during thoracoscopic thymectomy,” which appeared in the May 2019 issue of The Annals of Thoracic Surgery. The technique they described is an optimized method to establish the subxiphoid approach during thymectomy. Notably this technique provides a clear surgical view and improves the flow of the surgical procedure. The trans-subxiphoid thoracoscopic approach is an ideal approach for thymectomy in terms of less intercostal neuralgia and better operative views of the bilateral phrenic nerves and the upper area of the innominate vein. However the procedure does not allow easy manipulation, and much time is needed to create operative space in the retrosternal space. Therefore the authors introduced a simple method to establish the subxiphoid approach using a self-created gasbag made of a sterile glove in their study. The method did greatly shorten the time to separate the retrosternal space and obviously reduced the frequency of thoracoscope cleaning. However the inflated gasbag in the retrosternal space can compress the heart and lead to an increased heart rate, significantly so in our patients when the gasbag was inflated, even inflated with 500 mL of air. Based on these findings we raise a few issues that should be of concern in this method. First the amount of air should be adjusted flexibly according to the individual during surgery. The heart rate should not be greater than 100 bpm, and blood pressure should not be decreased while the gasbag is inflated. Second as gasbag is slowly inflated heart rate and blood pressure should be monitored. Finally a condom may be a better choice to be used than surgical gloves. The inflated condom can be applied to obtain an adequate surgical view around the observation port, and then the retrosternal space is fully detached using an ultrasonic scalpel. In this way changes in heart rate and/or blood pressure can be avoided. A Novel and Simple Method for Establishing the Subxiphoid Approach During Thoracoscopic ThymectomyThe Annals of Thoracic SurgeryVol. 107Issue 5PreviewThe transsubxiphoid thoracoscopic approach is an ideal method for thoracoscopic thymectomy. This report introduces a simple method to establish the subxiphoid approach. The surgeon made an incision and inserted a homemade gasbag into the retrosternal space. The gasbag was inflated with 600 to 800 mL of air. The inflated gasbag was maintained for 5 minutes and removed. This technique was performed in 20 cases. This method provides the surgeon with a good field of view, rare thoracoscope contamination, and a smoother surgical procedure. Full-Text PDF Homemade Gasbag Is Safe and Effective for Establishing the Subxiphoid Approach for ThymectomyThe Annals of Thoracic SurgeryVol. 113Issue 2PreviewIt is a pleasure to have received a letter from Mo and colleagues.1 In 2019, we introduced a simple method for establishing a subxiphoid approach during thymectomy.2 With our gasbag, a subxiphoid surgical field can be created safely and clearly. Full-Text PDF