Uniportal video-assisted thoracic surgery thymectomy.

Abstract

A 47-year-old gentleman presented with an incidental discovery of a 2.5-cm anterior mediastinal mass. Following radiological review, the diagnosis of likely thymoma is made and the patient is referred for surgical resection. The patient is currently self-employed and working as a carpenter. He is very concerned about the possibility of having a sternotomy as it would impact on his recovery and return to work. A single port, muscle sparing technique seems the best option for this gentleman. He undergoes surgery and is discharged 2 days later. He is back at work in 2 weeks. Over the past 10 years, video-assisted thoracic surgery (VATS) has replaced median sternotomy for the resection of anterior mediastinal masses, including thymoma. In 1993, the thoracoscopic approach to thymectomy was first reported by Sugarbaker from Boston, as well as a Belgian group (1,2). To date, the VATS approach has become the preferred and standard operation for the treatment of thymic disease. Numerous studies confirmed that, compared to standard sternotomy, VATS thymectomy results in less post-operative pain, better preserved pulmonary function, improved cosmesis (which can be particularly important to many young female myasthenia gravis patients) and is oncologically feasible for noninvasive thymomas as long as en bloc resection of the tumor is achieved (3-5). Most published reports regarding this procedure have focused on the right-sided approach, which has been adopted by most surgeons as the space in the right chest cavity is relatively large, with little interference from the heart, and the superior vena cava acts as an anatomical landmark. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Single-port thoracoscopy for mediastinal mass resection is not new. In our early experience with uniportal VATS thymectomy, we adopted the use of a singular access device (SILS port, Covidien) that permits the insertion of three or four instruments, together with CO2 insufflation, through a right-sided single 3-cm incision, without rib spreading.