Abstract
Aim: The advantages and feasibility of video-assisted thoracoscopic surgery (VATS) in the surgical management of early resectable thymoma and thymic hyperplasia have largely been described and adopted in many thoracic surgery units. In order to allow for resection of all immunogenic thymic cells in patients with myasthenia gravis, surgical removal of the whole thymus gland including perithymic and pericardiophrenic fatty tissue becomes imperative. It is also important to achieve radical resection and excision in cases of thymoma. Methods: Numerous technical variations of VATS thymectomy have been reported in literature. In this study, the surgical technique of a minimally invasive, extended thymectomy through a bilateral approach is illustrated with key features highlighted. Results: In our experience, no conversion to the open transternal approach, surgical mortality or major complications were observed; the median length of hospital stay was 3 days. Conclusion: Bilateral video-assisted extended thymectomy is an effective, safe and well-tolerated approach, with surgical benefits and clinical outcomes similar to other thoracoscopic techniques.
Highlights
Since the origin of this procedure, conventional open thymectomy has been considered the gold standard for the treatment of patients with thymomatous masses[1]
In 1993, Coosemans et al.[2] reported the first cases of video-assisted thoracoscopic surgery (VATS) thymectomy as a safe and effective approach, with or without additional trans-cervical incision
Many retrospectives studies comparing open trans-sternal thymectomy to VATS thymectomy have reported no significant difference in terms of adverse events, surgical extent, rate of R0 resection, peri- and post-operative complications
Summary
Since the origin of this procedure, conventional open thymectomy has been considered the gold standard for the treatment of patients with thymomatous masses[1]. In 1993, Coosemans et al.[2] reported the first cases of video-assisted thoracoscopic surgery (VATS) thymectomy as a safe and effective approach, with or without additional trans-cervical incision. With the improvement of technology, in terms of optical and surgical instrumentation, VATS thymectomy has become increasingly popular. Compared to the standard open technique, minimallyinvasive thymectomy has the advantages of reducing surgical trauma, less intraoperative blood loss and duration of postoperative pleural drainage, less postoperative pain, reduced hospital length of stay, better aesthetic result, rapid recovery of lung function and lower complications[3]. Many retrospectives studies comparing open trans-sternal thymectomy to VATS thymectomy have reported no significant difference in terms of adverse events, surgical extent, rate of R0 resection, peri- and post-operative complications. Faster recovery times were demonstrated in patients treated with bilateral thoracoscopic thymectomy for patients with MG[4]
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