Subxiphoid Uniportal Nonintubated Thymectomy

The authors present a thymectomy that was performed for a 49-year-old woman with a history of breast carcinoma who had a positron emission tomography–positive lesion at the level of the anterior mediastinum.

Her care was discussed at a multidisciplinary meeting and, although there was a suspicion of a malignant thymoma, the radiologist did not consider a computed tomography-guided biopsy to be a feasible option due to the position of the lesion. The patient was then referred for surgical excision.

Currently, the most common minimally invasive surgical approach for thymectomy is standard video-assisted thoracoscopic surgery (VATS).  However, it can be challenging to achieve satisfactory visualization of the whole thymus, and passing through the intercostal space can lead to postoperative acute and chronic pain due to intercostal nerve injuries.

Subxiphoid VATS has been developed as an alternative surgical approach that provides excellent visualization of both pleural cavities, including the phrenic nerves. Also, the subxiphoid approach has the advantage of avoiding an intercostal incision and intercostal manipulation, reducing pain and thus allowing early aggressive mobilization.

The concept of minimally invasive extends to the anesthetic field. In the video, Dr Guillermo Martinez explains the advantages of spontaneous ventilation and opioid-free anesthesia, which provides a quicker postoperative recovery and less side effects associated with conventional general anesthesia.

Additional Resources

Ali JM, Volpi S, Jiang L, et al. The future of minimally invasive thymectomy: the uniportal subxiphoid video-assisted thoracic surgery technique—a case series. J Vis Surg. 2018;4:222.