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2015 ; 4
(6
): 550-5
Nephropedia Template TP
Ann Cardiothorac Surg
2015[Nov]; 4
(6
): 550-5
PMID26693152
show ga
There are many techniques for performing video-assisted thoracoscopic (VATS)
thymectomy. This article describes one particular technique that we employ in
thymectomies as well as lobectomies. The principles of both operations are as
follows, and have been presented in greater detail for lobectomies previously:
(I) the use of ports no greater than 5-mm in the intercostal spaces; (II) the use
of a 12-mm subxiphoid port; (III) subxiphoid removal of the specimen; (IV) carbon
dioxide (CO2) insufflation; (V) vision enabled through a 5-mm camera; (VI) in
microlobectomies, the use of a 5-mm stapling device. These principles are
particularly suited to thymectomy, as there are no large vascular structures that
require stapling and a large number of the instruments required for thymectomy
are already 5-mm in diameter, including energy devices, graspers, clip
applicators and suction devices. We believe that this technique, which eliminates
the need for large incisions in the intercostal spaces, is less painful than
other techniques that we have employed, including intercostal uniportal surgery.
It also allows the use of CO2 insufflation, which is very useful indeed in
endoscopic thymectomies. Furthermore, microthymectomy is technically easier than
subxiphoid-only techniques, in that it requires little modification compared to a
more conventional VATS thymectomy. We describe this technique in detail in this
article.
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