MT has been advocated as an alternative approach to sternotomy for heart surgery. This method offers advantages such as reduced bone bleeding and increased thoracic stabilization. However, it also has some disadvantages. The duration of anesthesia and surgery can be prolonged due to technical difficulties, and the detection of accidental trouble can be delayed because of the limited surgical field of view [9]. These issues can be improved with increased surgeon experience. However, problems such as severe PTN, provoked by the MT incision, present another challenge that must be overcome, as it can lead to respiratory complications or other morbidity. Recently, with the increasing number of minimally invasive surgery via MT, there has been a growing interest in PTN control. IC is considered one of the viable treatments for PTN management. Cryoablation has traditionally been used under various conditions for the treatment of rib fractures, Nuss operation, and post-full thoracotomy pain. This approach has led to decreased opioid usage and postoperative visual analogue pain scores (VAS) [4]. Bauman et al., in a recent retrospective study, demonstrated reduced hospital length of stay (LOS), diminished need for narcotics, and consequent cost savings [10]. This method is considered an effective means to alleviate PTN and has shown positive results in this case patient. The disadvantage of IC lies in its invasiveness compared to alternative methods such as medication or percutaneous injection. Consequently, if the objective is solely pain management, there is the added complexity of administering treatment under general anesthesia. Moreover, nerves regenerate at a rate of approximately 3 mm/day along the remaining perineural structures, eventually restoring normal sensation [10, 11]. Nevertheless, excessive nerve damage can result in numbness [12, 13]. It’s worth noting that no specific side effects were identified in this case patient. However, it’s essential to remain mindful of these limitations when employing IC.

After surgery via MT, other potential side effects may occur due to thoracotomy, aside from PTN, including pulmonary hernia, rib fracture, and intercostal hemorrhage [14, 15]. Surgeons and patients must always consider these complications alongside PTN. Controversy persists regarding the necessity of surgical repair for intercostal hernias, as they typically do not present a significant threat unless complications such as incarceration and strangulation occur, leading to symptoms such as hemoptysis and pain. While both surgical and conservative approaches are advocated, spontaneous recovery of lung herniation is improbable [15]. Therefore, in cases where lung herniation poses a risk to the patient’s well-being (e.g., hemoptysis, decreased oxygen saturation, severe pain), surgical intervention may be warranted. In this case, the patient presented with chronic PTN and a lung hernia after MT surgery. Despite opioid medication and local anesthetic injections, the pain persisted and even increased. For such patients, surgical IC treatment and repair of the hernia can be a viable option. It has been shown to provide excellent analgesia along with decreased hospital length of stay and reduced use of narcotics, thereby improving the patient’s quality of life. Our findings indicate that concurrent IC and mesh repair can effectively relieve chronic PTN pain in MT patients and lead to a reduction in opioid medications.