Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results

Abstract

OBJECTIVES: Compared with conventional median sternotomy, approaches used in thymectomy for myasthenia gravis and anterior mediastinal tumours have become much less invasive in recent years. We previously developed a surgical technique called single-port thymectomy (SPT) to excise the thymus through a single opening made below the xiphoid process. In this study, to show the utility of SPT, we compared factors contributing to low surgical invasiveness between SPT and conventional video-assisted thoracoscopic surgery (VATS) thymectomy. METHODS:Between January 2005 and December 2014, 146 patients underwent surgery for anterior mediastinal tumour or myasthenia gravis at our hospital. After excluding patients diagnosed with tumour invasion of nearby organs or those who had undergone concurrent removal of nearby organs, 81 patients were enrolled in this retrospective study as subjects. Patients were divided into the VATS thymectomy group (VATS group, n = 35) and the SPT group (n = 46). Surgical duration, blood loss, duration of hospital stay and the amount and duration of postoperative oral analgesics were compared between the groups. RESULTS:Operating time did not vary significantly between the VATS and SPT groups (P = 0.0853). The amount of blood loss was higher in the VATS group than in the SPT group (P < 0.0001). The duration of hospital stay was longer in the VATS group than in the SPT group (P = 0.0008). The amount of postoperative oral analgesics was significantly higher in the VATS group than in the SPT group (P = 0.0092). Similarly, the duration of postoperative oral analgesics was significantly longer in the VATS group than in the SPT group (P = 0.0312). CONCLUSIONS:Compared with VATS thymectomy, SPT required a similar operating time, was associated with less blood loss and enabled postoperative analgesics to be discontinued earlier. Therefore, it could be considered a less invasive surgical approach.

Minimally invasive surgical procedures for thymic disease in Asia

“…Recently, Suda et al in Japan introduced a single-port thymectomy technique performed through a subxiphoid incision and reported the superiority of this approach in comparison to a conventional VATS method in regard to duration of hospital stay, and amount and duration of postoperative oral analgesics (14).…”

Subcostal thoracoscopic extended thymectomy for patients with myasthenia gravis

“…The subxiphoid uniportal thoracoscopic approach has been proved feasibility for extended thymectomy (5-7). However this procedure needs to remove the xiphoid process and a 3-4 cm transverse incision, and it needs some special surgical instruments such as autonomy grasper (7). Differential lung ventilation was also needed in the subxipoid uniportal thoracoscopic thymectomy and that may damage lung function.…”

Subxiphoid thymectomy: single-port, dual-port, and robot-assisted

“…In 2012, we reported on single-port thymectomy (SPT) using carbon dioxide (CO 2 ) insufflation (8,9). The advantages of this technique are as follows: (I) the field of view offered by the camera scope inserted from the midline of the body helps confirm the location of the superior pole of the thymus and bilateral phrenic nerves; (II) pain is minimal and no intercostal neuropathy occurs because intercostal spaces are not traversed; and (III) cosmetic outcomes are excellent (10). A drawback of this approach is that it requires familiarity with the single-port surgical procedure.…”