Uniportal subxiphoid thoracoscopic thymectomy using percutaneous suspension technique for giant anterior mediastinal mass resection: a case report

Resection of giant anterior mediastinal masses (AMMs) has traditionally required median sternotomy as the limited operative space and visibility of conventional video-assisted thoracoscopic surgery (VATS) pose significant technical challenges. In this study, we describe a percutaneous suspension technique using a Tian-Ping sternal lifter, to facilitate uniportal VATS for the complete resection of a giant teratoma. A 28-year-old Chinese female presented with a three-month history of intermittent chest pain and cough. Computed tomography (CT) revealed a 17.0 × 9.0 cm AMM with heterogeneous density, and positron emission tomography/computed tomography (PET/CT) demonstrated increased metabolic activity. Complete tumor resection was achieved via a uniportal subxiphoid VATS approach, with operative exposure enhanced by a Tian-Ping sternal lifter that expanded the retrosternal working space. The patient had an uneventful recovery and was discharged nine days after surgery. Histopathology confirmed a mature cystic teratoma. At 18-month follow-up, the patient remained asymptomatic with no recurrence or procedure-related complications. This single-case report illustrates the feasibility of a percutaneous suspension technique using a Tian-Ping sternal lifter to assist uniportal subxiphoid VATS resection of large AMMs, offering a minimally invasive, sternum-sparing option for selected patients.