En-bloc Resection of Advanced Thymic Carcinoma with Innominate Vein and Aorta Adhesion: Video and Case Sharing

Background: This 70-year-old female was diagnosed with thymic carcinoma, modified Masaoka stage IIa, with innominate vein and aorta adhesion.Primary treatment plan was neoadjuvant treatment first then salvage surgery.However, she underwent septic shock during the chemotherapy.Hence, operation resection was considered.Methods: We positioned the patient in the supine position, and performed robotic assisted thoracoscopic total thymectomy combined tumor en-bloc resection from subxiphoid route.Results: The patient tolerated the entire operation smoothly.Pathology report revealed tumor en-bloc resection with clear margin.The postoperative complication was swelling in the left upper arm due to innominate vein ligation, which improved after 1 month.Conclusion: Robotic-assisted thoracoscopic surgery was safe enough for the patient, who was considered necessary to undergo a sternotomy for the safety of en-bloc tumor resection.In the meanwhile, complications are acceptable.