Subxiphoid single incision thoracoscopic surgery approach for thymectomy: a case report

Abstract

Thoracic surgery is rapidly evolving with minimally invasive strategies now dominating.Thymectomy has traditionally been performed through a sternotomy, but more recently video-assisted thoracoscopic surgery (VATS) approaches have become increasingly popular. To further minimise surgical impact, the uniportal subxiphoid VATS technique has recently been described, using a muscle sparing incision that avoids intercostal nerve injury. A potential advantage that makes this approach particularly suited to thymectomy includes the ability to access both sides of the chest with a single incision. There is also the potential for reduced post-operative pain and chronic thoracostomy neuralgia. Here we describe the management of a patient with thymoma, reporting our procedure and technique for performing uniportal subxiphoid VATS thymectomy.

Robot‐assisted thoracic surgery versus video‐assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta‐analysis

“…Several studies have found that by using the subxiphoid approach during surgery, the thymoma tissue, diagnosed as Masaoka III, invades the pericardium, lung tissue, and the left innominate vein can also completely be removed and reduce postoperative pain. [36][37][38][39][40] In our subgroup analysis, the results showed that for surgery with the unilateral thoracic approach, the RATS group was still associated with lower blood loss, shorter length of postoperative hospital stay and postoperative duration of drainage, and fewer postoperative complications. For the subxiphoid approach, the RATS group had a shorter duration of postoperative drainage time, lower volume of drainage.…”

“…Several studies have found that by using the subxiphoid approach during surgery, the thymoma tissue, diagnosed as Masaoka III, invades the pericardium, lung tissue, and the left innominate vein can also completely be removed and reduce postoperative pain. 36 , 37 , 38 , 39 , 40…”

Uniportal subxiphoid video-assisted thoracoscopic approach for thymectomy: a case series

“…To date there are only isolated case reports describing the uniportal subxiphoid-VATS technique for thymectomy (12,13). This case series adds further to the evidence that the subxiphoid-VATS uniportal approach is a safe and appropriate method for thymic resection in a selected patient group, i.e., non-obese patients with Masaoka stage 1 tumours and without significant underlying cardiorespiratory disease.…”

Subxiphoid pneumonectomy: the new frontier?

“…In the case of standard VATS, there are reports of requiring rib spreading and the lung being retrieved in pieces. Furthermore, retrieval may result in compression of the intercostal nerves which can result in chest wall pain which may be chronic in some patients More recently, the subxiphoid uniportal VATS technique has been described, avoiding any intercostal incision or instrumentation (14)(15)(16)(17)(18)(19)(20)(21)28,29). Additionally, since the chest drains are not entering the thoracic cavity through intercostal spaces postoperatively, they do not impinge on the intercostal neurovascular bundle during mobilization of the patient.…”