Uniportal video assisted thoracoscopic surgery thymectomy (left approach)

Video assisted thoracoscopic surgery (VATS) thymectomy for the management of myasthenia gravis and thymoma has been described and routinely performed. With the advent of single port surgery, uniportal thymectomy has gained popularity and left side approach is preferred only if the suspecting tumour is situated on the left mediastinum. However, many doubt or dislike the left side VATS approach to anterior mediastinum as the ventricular apex renders maneuverer of instruments difficult. This is certainly not the case as shown in this video and to date, there is no published manuscript on left uniportal thymectomy.

Patient positioned semi-supine with left sided propped up and the ipsilateral arm placed naturally and secured by the side and below the chest wall. Cleaned and draped as for sterile procedure. General anaesthesia and lung isolation achieved with a double lumen endotracheal intubation. A 2.5 cm incision was made at 4^th intercostal space, anterior axillary line (lateral to nipple line). Extra small size wound protector was used and CO₂ insufflation was not needed. Instruments utilised in this case were "not new" and used for laparoscopic surgery 2 decades ago. This video demonstrates the simple technique of left uniportal approach to total thymectomy. Safe en bloc resection of thymus and thymic tumour with surrounding fatty tissue were performed, by combination of careful pleura dissection using diathermy, traction and blunt dissection of thymus. Extra caution when dividing thymic vein branches from innominate vein is prudent in order to prevent intra-operative haemorrhage and subsequent conversion to sternotomy or thoracotomy.

In this video, total thymectomy was performed without complication. The specimen was removed through the port and a single chest tube was placed at end of procedure for 1 day. Patient went home uneventfully on day 2.

Left uniportal VATS thymectomy is feasible, and preferred for left sided thymoma. This simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.