Rib Resection Using a Gigli Saw Under VATS Guidance

A 20-year-old woman came to the author’s clinic complaining of chest pain that had lasted three months. Computed tomography demonstrated a 3 × 2.8 cm lesion in the anterior segment of the left fifth rib. Bone scintigraphy showed increased activity in the left fifth rib. It was recommended that the patient undergo rib resection with VATS guidance.

The patient was placed in the right lateral decubitus position, and double lumen intubation was performed to achieve unilateral ventilation. A port incision was placed behind the posterior axillary line at the level of the seventh interspace to accommodate a 5 mm thoracoscope. The borders of the rib lesion were marked with needles, and two additional ports were placed 2.5 cm anterior and posterior to the lesion under thoracoscopic control. The parietal pleura inferior to the fifth rib was opened with electrocautery. Periosteal tissues at the proximal and distal ends of the fifth rib were dissected. The intercostal vessels were coagulated and cut with electrocautery. The lower margin of the fifth rib was looped with a Gigli saw, and the fifth rib was transected. The upper margin of the fifth rib was transected in the same manner. A 5 cm segment of the rib was resected, and a bag was inserted into the thoracic cavity through the port for removal of the rib segment. The operative port incisions were sutured and one chest tube was inserted via the camera port wound. The total surgery time was 50 minutes.

The chest tube was removed on the second postoperative day. The patient was discharged on postoperative day three without complications. The pathologic diagnosis was osteochondroma.