Minimally Invasive Thymectomy for Early-stage Thymomas without Myasthenia Gravis: Modified Subxiphoid Thoracoscopic Approach versus Unilateral Thoracoscopic Approach

Jianyong Ding, Hao Wang

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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

Abstract

Objective

Conventionally minimally invasive thymectomy for thymoma is performed via unilateral thoracoscopic approach. However it is criticized for bad exposure of anterior mediastinum and contralateral area which may be disadvantagous for surgery. We attempted modified subxiphoid thoracoscopic approach with innovative sternal-elevating technique to reach better surgical exposure.

Methods

From January 2015 toOctober 2017, a total of 198patients with clinically early-stage thymoma without myasthenia gravis were enrolled. Between them,102 patients were performed thoracoscopic thymectomy via subxiphoid approach (Group S) . Three subxiphoid incisions (12mm*1, 5mm*2) with the aid of artificial CO₂ pneumothorax were used. Additionally, we used the sternum-elevating device(Rul-tractor, USA) through the 3rd intercostal incision (5mm*1) beside the sternum. And the other 96 cases underwent conventional thymectomy via unilateral 3-port thoracoscopic approach (Group UL). The outcome were compared.

Results

The two groups were comparable on patients＇demographics, such as age, gender, tumor size, WHO type and Masaoka staging. Two cases were converted to open surgery in Group S ( 1 case due to bleeding and 1 due to technical difficulty）, while 2 cases were converted to open surgery in Group UL（1 case due to bleeding and 1 due to tumor invasion）. No significant difference was found  on blood loss[(53±38)ml vs (55±48)ml, p=0.721]. Compared with Group UL, patients in Group S had much less surgical duration [(57±17)min vs (65±14)min, p=0.029] , less pain scores (2.6±1.2 vs 3.3±1.1, p=0.004) , earlier drainage removal [(1.5±0.7)d vs (2.5±0.8)d, p=0.000] and less postoperative hospital stay[2(1～6)d vs 3(2～9)d, p=0.000]. The complications were similar (5.9% vs 7.3%, p=0.689). And no perioperative death occurred.

Conclusions

This study suggests that the modified subxiphoid thoracoscopic approach seems to be more effective for thymectomy for early-stage thymoma. This novel approach could improve surgical exposure, accelerate the operative progress and result in less trauma and faster recovery.