Left-sided VATS + Subxiphoid: a Minimal Invasive Way to Deal with Large Non-infiltrative Thymic Tumors

Jose R. Matilla, Bernhard Moser, Walter Klepetko

Thoracic Surgery Department. Vienna University Hospital, Vienna, Austria

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–C

Abstract

Objective: There is no standard surgical approach to deal with thymic pathologies, and if those thymic disorders represent lesions with diameter larger than 4 cm, resection and specimen retrieval in non-open surgery could be challenging.

Methods: In our initial experience dealing with such lesions in a minimal invasive way, we combined the left sided three ports VATS approach using CO2 insuflation with a single 4 cm subxiphoid incision to achieve radical resection and remove the specimen at the end of the procedure.No sternal lifting device was needed and right sided tumor predominance did not affect surgical approach.

Results: 5 Patients were operated using this technique with thymic disorders larger than 4cm. This approach facilitates not only the removal of the specimen, but also a more radical right sided mediastinal dissection with a safe preservation of the right phrenic nerve: no iatrogenic phrenic injury was observed in this initial experience. Blood loss was always less than 200 ml and all patients were discharged at third post-operative day with only minimal discomfort at the subxiphoidal region.

Conclusions: This procedure offers a safe option to deal with non-infiltrative Thymomas allowing a bilateral radical resection with perfect control over both phrenic nerves. In the future we will consider such approach if lesions have a diameter of more than 4 cm and in patients with Myasthenia Gravis where more challenging right side dissection is expected.