Uniportal video assisted thoracoscopic surgery thymectomy (right approach).

BACKGROUND

Video assisted thoracoscopic surgery (VATS) thymectomy for the management of myasthenia gravis and thymoma has been described and routinely performed. With the advent of single port surgery, uniportal thymectomy has gained popularity as it has the advantages in terms of improved cosmesis, less surgical trauma and financial savings in particularly over robotic thymectomy. The approach demonstrated in this video also negates the problems of sub-xiphoid route in patient with obesity, cardiomegaly, and limitations of instruments manoeuvrability.

METHODS

Patient positioned semi-supine with right sided propped up and the ipsilateral arm placed naturally and secured by the side and below the chest wall. Cleaned and draped as for sterile procedure. General anaesthesia and lung isolation achieved with a double lumen endotracheal intubation. A 2.5 cm incision was made at 5 intercostal space, anterior axillary line (lateral to nipple line). Extra small size wound protector was used and CO insufflation was not needed. Instruments utilised in this case were "not new" and used for laparoscopic surgery 2 decades ago. This video demonstrates the simple technique of right uniportal approach to total thymectomy. Safe en bloc dissection of thymus and thymic tumour with surrounding fatty tissue were performed by combination of careful pleura dissection using diathermy, traction and blunt dissection of thymus. Extra caution when dividing thymic vein branches from innominate vein is prudent in all thymic dissection and prevent intra-operative haemorrhage and subsequent conversion to sternotomy or thoracotomy.

RESULTS

In this video, total thymectomy was performed without complication. The specimen was removed through the port and a single chest tube was placed at end of procedure for 1 day. Patient went home uneventfully on day 2.

CONCLUSIONS

Right uniportal VATS thymectomy is feasible, and this simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.