Surgical Management of Unexpected Thymic Anatomical Variations During Thoracoscopic Thymectomy

Complete thoracoscopic thymic resection is crucial for achieving sternotomy-comparable outcomes in myasthenia gravis patients. Thymic anatomy varies significantly, presenting features like retro-left brachiocephalic vein (LBCV) horns and thymic ring. Surgeons encountering these variations may miss abnormal thymic tissue or face intraoperative challenges. This research aims to report on the thoracoscopic management of thymic variations, illustrating their perioperative outcomes.

This retrospective observational study was conducted from September 2016 to September 2024. A total of 255 myasthenic patients underwent thoracoscopic thymectomy and were categorized into Normal (n = 227) and Variant (n = 28) groups based on intraoperative anatomical variations. Primary outcomes were operative time and blood loss. Secondary outcomes included hospital stay and postoperative outcomes. Perioperative data were compared between groups.

In the Variant group, the most commonly identified anatomical variations were thymus with "more than 2 horns" (12 patients, 42.9%), followed by retro-LBCV horns (9 patients, 32.2%). The mean operative time was significantly longer in the Variant group (209.36 ± 53.69 minutes) compared to the Normal group (177.26 ± 57.41 minutes) (P = .005). Otherwise, both groups did not exhibit significant differences regarding other perioperative data and neurological outcomes.

Thoracoscopic thymectomy can be safely and effectively performed even in the presence of thymic anatomical variations, especially when they are preoriented by the surgeon. While these variations may lead to longer operative times, they do not compromise completeness of resection and other short-term postoperative outcomes.