Subxiphoid Uniportal VATS for Thymic and Combined Mediastinal and Pulmonary Resections - A Two-Year Experience

Compared to the intercostal approach, subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) is considered to be less invasive as it may cause minimal postoperative pain. Besides, it provides an excellent view of the bilateral pleural cavities. In this paper, we describe our technique and overview a 2-year experience results in this approach for the surgical treatment of anterior mediastinal and pulmonary lesions. In a retrospective study of data collected prospectively between October 2014 and December 2016, 38 patients underwent surgery for an anterior mediastinal tumor or myasthenia gravis at our institution. Intraoperative factors like duration of operation and amount of blood loss were analyzed as well as postoperative ones, including duration of chest drains, amount of postoperative fluid drainage, and length of hospital stay. The median age of patients was 59 years (36-80 years) with 19 females (50%). Overall, 28 patients (74%) underwent extended thymectomy. Seven patients (19%) experienced a combined lung resection and extended thymectomy, 3 (7%) a resection of pericardial (2) or bronchogenic (1) cysts. The median diameter of the lesions was 2.93 cm (1.2-7.7 cm). Postoperatively, 30-day mortality was 0%. Subxiphoid uniportal VATS is a convenient approach for minimally invasive mediastinal surgery. The excellent exposure of the anterior mediastinum and the possibility of conducting complex procedures, such as extended thymectomies and combined mediastinal and pulmonary resections with good results of minimal morbidity, represent the strong points of this technique. Thoracic surgeons experienced in VATS can safely perform subxiphoid uniportal VATS for mediastinal surgery.