Article Abstract

The future of minimally invasive thymectomy: the uniportal subxiphoid video-assisted thoracic surgery technique—a case series

Authors: Jason M. Ali, Sara Volpi, Lei Jiang, Chenlu Yang, Liang Wu, Gening Jiang, Giuseppe Aresu

Abstract

Background: Thymectomy for early thymic tumours is rarely performed by sternotomy in the current era of minimally invasive thoracic surgery. With standard video-assisted thoracic surgery (VATS) it can be difficult to visualise the entire thymus. Subxiphoid VATS (SVATS) has been developed as an alternative surgical approach which is particularly suited to performing thymectomy due to providing visualisation of both pleural cavities. This study reports a large case series of uniportal SVATS extended thymectomy.
Methods: Over the period of study, 39 patients underwent uniportal SVATS extended thymectomy for a thymic nodule at the Shanghai Pulmonary Centre. Seventeen patients were female, and the mean age of the cohort was 60 years. The mean size of nodule was 30.27 mm.
Results: The mean operative duration was 2.1 hours, with one conversion to thoracotomy for bleeding. The mean operative blood loss was 93 mL. The median length of hospital stay was 4 days. There were no episodes of phrenic nerve palsy and the 30-day survival was 100%. Comparing the first and second cohorts, there was reduced operative time (P=0.005), reflecting the learning curve.
Conclusions: The uniportal SVATS technique is safe and feasible for performing extended thymectomy. It allows the surgeon to perform a radical oncological thymectomy with lower risk of damaging adjacent nerves and vessels. The procedure can be performed safely during the learning curve period.