The first experience of thoracoscopic thymectomy from a unified subxiphoid access

BACKGROUND: Thoracoscopic thymectomy performed with using the lateral intercostal access in cases of non-invasive thymic tumors is the commonly used technique. Most frequently, the three-port and the single-port techniques are used. As the experience was accumulating, it became evident that the intercostal access has a number of disadvantages, such as unsatisfactory visualization of the nerve on the opposite side and of the cervical portion of the thymus, along with a probably of developing chronic pain syndrome. One of the possible solutions for this issue can include the use of sub-xyphoid access. AIM: An evaluation of direct results obtained when using the unified sub-xyphoid access during thoracoscopic thymectomy in patients with non-invasive epithelial thymic tumors. METHODS: An experience was analyzed that was gained after the treatment of 14 patients undergoing thoracoscopic thymectomy using the unified sub-xyphoid access for non-invasive epithelial tumors of the thymus. The age of the patients ranged from 24 to 70 years (median — 42 years); 9 of them were females (64.3%) and 5 were males (35.7%). In all the patients, at the moment of surgical treatment, stage I disease was diagnosed. The minimal dimension of the excised thymoma in this research was 15 mm with the maximal dimension being 65 mm, the median value was 38 mm. RESULTS: Two surgeries (14.3%) were accompanied with technical difficulties due to the presence of an adhesion process after a previous episode of pulmonary inflammation, which resulted in more significant intraoperative blood loss, which was 200 ml. The surgery duration varied from 60 to 180 minutes with the median of 82.5 minutes. In the majority of cases (97.6%), the pain syndrome level did not exceed 4 points of the visual analogue scale for pain. During the postoperative period, a single surgical complication was reported — the development of the retrosternal hematoma; no fatal outcomes were reported. CONCLUSION: The thoracoscopic thymectomy from the unified sub-xyphoid access is a justified option for cases of non-invasive epithelial thymic tumors. This method allows for performing the surgery in full range, not violating the oncology principles. It was proven that, for tumors measuring up to 65 mm, this method does not result in an increase in surgery duration or an increase in the rates of intraoperative complications.