Left-sided approach video-assisted thymectomy for the treatment of thymic diseases

Video-assisted thoracoscopic thymectomy was developed more than 10 years ago and has become a widely accepted surgical approach. Most published reports regarding this procedure have focused on the right-sided approach. Since left-sided approach chest surgery is the first choice in cases of right pleural adhesion, large left thymus tumors, and tumors in close contact with the great vessels of the left pericardium, we performed thoracoscopic thymectomy using the left-sided approach in 52 cases and summarize herein its technical feasibility, indications, and operative steps.

Between February 2004 and October 2014, 52 patients (24 men, 28 women, median age: 50 years, ranging from 18 to 85 years), underwent a video-assisted thoracoscopic thymectomy using the left-sided approach. All procedures were performed under general anesthesia with single-lung ventilation. Patients were placed in the right lateral decubitus position and three ports were made. The entire hemithorax was carefully examined, then mediastinal pleura was incised, and the thymus was bluntly dissected from the inferior polar extending to the superior polar. The thymic venous was clipped.

All procedures were carried out safely, including simple thymectomy (n = 43) and extended thymectomy (n = 9). There were no operative deaths or serious complications, and there were seven cases of conversion to open thoracotomy. The mean operative duration was 105.3 minutes (ranging from 80 to 140 minutes). The mean blood loss was 78.5 ml (ranging from 20 to 200 ml), and there was no blood transfusion required. All patients were well throughout the follow-up period.

The left-sided approach for video-assisted thoracoscopic thymectomy was a safe approach and could be an alternative procedure to the right-sided approach for the same procedure.