VATS thymectomy in left atrial isomerism

Thymectomy is performed for the treatment of myasthenia gravis (MG) and the removal of thymic lesions. Minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have now become a standard of care for thymectomies. We present the case of a woman in her early 50s with non-thymomatous MG and left atrial isomerism. As part of left atrial isomerism, she had bronchial isomerism with no right middle lobe, hemiazygous vein continuation of the inferior vena cava, bilateral superior vena cavae and no left brachiocephalic vein. A bilateral VATS approach provided a safe and effective technique for the removal of the thymus and the patient was discharged on postoperative day 2. While considerations must be taken from both the anaesthetist (altered bronchial anatomy) and operator (aberrant venae cavae and brachiocephalic veins), minimally invasive techniques can provide an effective alternative to open thymectomy in patients with anomalous anatomy.