Thoracoscopic resection of bulky thymoma assisted with artificial pneumothorax: A report of 19 consecutive cases

The aim of the present study was to examine the feasibility and efficacy of thoracoscopic radical resection of large retrosternal thymoma using artificial pneumothorax. A retrospective analysis was performed on 19 patients with bulky thymoma who underwent thoracoscopic resection using artificial pneumothorax by CO₂ insufflation. The operations were performed with unilateral or bilateral thoracic incisions via single lumen endotracheal intubation and two-lung ventilation. This approach provided excellent exposure of the thoracic cavity and reliable control of the neuro-vascular structures in the anterior mediastinum, which was of vital importance for the extended resection of malignant thymoma. The operation time was 140.0±51.4 min without conversion to thoracotomy or sternotomy. The pathological diagnosis was confirmed by immunohistochemistry, including 5 cases of thymus lipomyoma, 1 case of thymus hyperplasia, 1 case of thymus cyst, 2 cases of type AB thymoma, 4 cases of type B1 thymoma, 4 cases of type B3 thymoma, and 2 cases of thymic carcinoma. Furthermore, there were no complications such as recurrent laryngeal nerve injury, phrenic nerve injury, pulmonary infection or atelectasis, with a hospital stay of 5.0±3.0 days. In conclusion, the thoracoscopic resection of thymoma using artificial pneumothorax is a preferable approach, that may be considered for patients with bulky retrosternal tumors.