Background

Thymomas are the most frequently occurring tumors of the anterior mediastinum and commonly develop between ages of 35 and 75 years. Approximately 30% to 45% of patients develop symptoms of myasthenia gravis and one third of patients are asymptomatic at the time of diagnosis. Local symptoms such as chest pain, hoarseness, shortness of breath, cough, superior vena cava syndrome, stridorous breathing are due to compression or direct invasion of adjacent structures and are present in as many as 40% of patients. Complete resection is the cornerstone of treatment and several studies have been published comparing different minimally invasive approaches to open resection for thymic malignancies. We present our experiences with minimally-invasive VATS thymectomy.

Key words: Thymectomy, VATS, Thymoma

Materials and methods

Between March 2015. and February 2016. eleven patients with thymomas were surgically treated by performing VATS thymectomy. Ten female patients and a single male patient, with an average age of 45.1 years (median 34 – 66) were enrolled into this study. Seven patients had been previously diagnosed with myasthenia gravis, and according to Masaoka – Koga classification, eight patients had Stage 1 and three patients Stage 2 disease. The patient was positioned in a 30 degree semi-supine position with a roll placed under the shoulder, and the ipsilateral arm held abducted over a padded L-screen for exposure of the axilla. Surgical approach was conducted using right-sided 3 ports, one 10 mm and two 5 mm ports.  Lung isolation is obtained with a double lumen endotracheal tube supplemented with initial carbon dioxide insufflation (5-8mmHg pressure at 4L/min flow rate) for rapid initial collapse of the lung. Dissection was performed using a harmonic scalpel and en bloc resection of the entire thymus gland and surrounding mediastinal fatty was preformed. The specimen was removed using an endo-bag introduced through 2 cm long incision previously used as a camera port.

Results

There were no perioperative complications. All patients were extubated at the end of the procedure. Mean duration of surgery was 75 minutes (45min – 105min). On average chest drainage was removed on the second postoperative day. Average hospital stay was 4.4 days (3 – 6 days). All removed tumors were identified as thymomas upon histological examination. Among myasthenic patients 90% had improvement in symptoms with 80% being asymptomatic and a fifth of patients were in complete remission without medical therapy.

Conclusion

Shorter operative time reduced intraoperative blood loss, decreased postoperative pleural drainage and shorter hospital stay makes VATS thymectomy a method of choice for patients with Masaoka – Koga stages I. and II thymomas.

Ilic N., Krnic D., Juricic J., Orsulic D., Simundza I., Urlic M.
Department of Thoracic Surgery, University Hospital Split, Split, Croatia

Corresponding presenting author's e-mail: joskojuricic123@gmail.com

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