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DOI: 10.1055/s-0039-1694255
Subxiphoid video assisted thoracoscopis thymectomy – our experiences
Publication History
Publication Date:
04 September 2019 (online)
Background:
The treatment of choice in thymomas is surgical resection. In the past, sternotomy was considered as standard. However, nowadays the minimally invasive technology is of rising interests in thoracic surgery.
Material and method:
The whole procedure was conducted through a 5 cm transverse subxyphoidal incision. In addition, two intercostal 10 mm ports where used to insert the camera. Double elevation of the sternum with modified Rochard retractor was utilized to achieve the optimal view and to facilitate the dissection. After the mediastinal resection, one chest tube was applied to each pleural cavity.
Result:
The study includes 14 Patient (7 women, 7 men) with a mean age of 57.13 (range 38 – 71) years.
Because of the size of the tumor two cases were converted to sternotomy.
The mean time of surgery for subxiphoidal video-assisted thoracostopic approach was 188 minutes (range 70 – 259 minutes).
Histological finding were as follows: thymic hyperplasia in two patients, thymic cyst in two patients, thymoma Masaoka Koga I in five patients, Masaoka Koga IIA in two patients and Masaoka Koga IIB in one patient.
The chest tubes were removed after a mean duration of 2.75 days (range 1 – 4 days).
There was no postoperative 30 day mortality in the cohort. One patient suffered from right recurrent nerve palsy (in that case a simultaneous strumectomy was performed). One additional patient was revised because of bleeding from the jugular incision and finally in one patient thoracentesis due to pleural effusion after drain removal was needed.
Mean postoperative hospital stay was 4.42 days (range 2 – 7 days).
Conclusion:
The Subxiphoidal approach is a safe and effective technique with low incidence of morbidity and short hospital stay that enables extensive thymectomy. Thus we concluded that the benefit of subxyphoidal approach is characterized on the one hand by its minimal invasive approach and on the other hand by its maximal surgical exposure.