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VATS thymectomy in left atrial isomerism.

Edward Staniforth^1,2, Anchal Jain³, Rhona Taberham³

¹General Surgery, Mid Yorkshire Teaching NHS Trust, Wakefield, UK edward.staniforth@nhs.net.

BMJ Case Reports

|December 3, 2025

Summary

Video-assisted thoracoscopic surgery (VATS) offers a safe and effective minimally invasive approach for thymectomy in myasthenia gravis (MG) patients, even those with complex congenital anomalies like left atrial isomerism.

Keywords:

Cardiothoracic surgery Cardiovascular medicine Congenital disorders Mechanical ventilation Surgical Procedure, Operative

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Left Atrial Stenosis Induced Pulmonary Venous Arterialization and Group 2 Pulmonary Hypertension in Rat

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Published on: November 18, 2018

Area of Science:

Thoracic Surgery
Minimally Invasive Procedures
Myasthenia Gravis Management

Background:

Thymectomy is a standard treatment for myasthenia gravis (MG) and thymic lesions.
Video-assisted thoracoscopic surgery (VATS) is increasingly adopted as a minimally invasive standard for thymectomy.
Anatomical variations can pose challenges during thymectomy.

Purpose of the Study:

To present a case of thymectomy using a bilateral VATS approach in a patient with non-thymomatous MG and complex left atrial isomerism.
To highlight the feasibility and safety of minimally invasive thymectomy in patients with anomalous anatomy.

Main Methods:

A bilateral VATS approach was utilized for thymectomy.
Careful pre-operative planning considering the patient's unique anatomy was essential.

Main Results:

The bilateral VATS thymectomy was successfully performed.
The patient was discharged on postoperative day 2, indicating a safe and effective procedure.
The procedure demonstrated the viability of VATS in managing complex anatomical variations.

Conclusions:

Minimally invasive thymectomy, specifically VATS, is a safe and effective alternative to open surgery for patients with myasthenia gravis and complex congenital anomalies.
Anesthetists and surgeons must be aware of and prepared for potential anatomical challenges, such as altered bronchial and venous anatomy, when performing VATS in these patients.