Video-assisted thoracoscopic microthymectomy.

There are many techniques for performing video-assisted thoracoscopic (VATS) thymectomy. This article describes one particular technique that we employ in thymectomies as well as lobectomies. The principles of both operations are as follows, and have been presented in greater detail for lobectomies previously: (I) the use of ports no greater than 5-mm in the intercostal spaces; (II) the use of a 12-mm subxiphoid port; (III) subxiphoid removal of the specimen; (IV) carbon dioxide (CO2) insufflation; (V) vision enabled through a 5-mm camera; (VI) in microlobectomies, the use of a 5-mm stapling device. These principles are particularly suited to thymectomy, as there are no large vascular structures that require stapling and a large number of the instruments required for thymectomy are already 5-mm in diameter, including energy devices, graspers, clip applicators and suction devices. We believe that this technique, which eliminates the need for large incisions in the intercostal spaces, is less painful than other techniques that we have employed, including intercostal uniportal surgery. It also allows the use of CO2 insufflation, which is very useful indeed in endoscopic thymectomies. Furthermore, microthymectomy is technically easier than subxiphoid-only techniques, in that it requires little modification compared to a more conventional VATS thymectomy. We describe this technique in detail in this article.