Modified subxiphoid thoracoscopic thymectomy for early-stage thymic tumor: case report

Minimally invasive thymectomy via subxiphoid is increasingly being used for thymic tumors. Limited by the small space behind the sternum, the subxiphoid approach is sometimes difficult to perform. In this study, we introduce a modified subxiphoid thoracoscopic thymectomy which is performed via subxiphoid approach using an auxiliary sternal retractor to elevate the sternal to create a larger space behind the sternum. Therefore, the phrenic nerves on both sides were revealed more clearly and the left innominate vein was mobilized safer and easier.

This study describes the treatment process of a 27-year-old female patient with an incidental finding of a thymic mass. Chest contrast computed tomography revealed a 35 mm × 25 mm lesion in the anterior mediastinum which might be adherent to the left innominate vein. A careful preoperative evaluation was well done and no contraindications to the operation were found. This patient underwent modified subxiphoid thoracoscopic thymectomy, successfully completed without complications occurred during the perioperative period. The patient was discharged home well on post-operative day 2. The pathological diagnosis was mature teratoma.

In conclusion, modified subxiphoid thoracoscopic thymectomy using an auxiliary sternal retractor makes minimally invasive thymectomy safer and simpler and is an alternative option for patients with early-stage thymic tumors.