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Updated: Apr 11, 2026
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Published on: February 27, 2026
Surgical outcomes of thoracoscopic extended thymectomy via subxyphoid and left intercostal approach
Zhenlin Jiang1, Zuxin Dong1, Junting Chen1
1Department of Thoracic Surgery, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha City, Hunan, China.
Background:
Minimally invasive thymectomy is widely adopted for the management of thymic diseases and myasthenia gravis (MG). Among thoracoscopic techniques, the intercostal approach (ICA) is the most commonly used, whereas the subxiphoid approach (SA) has been proposed to reduce postoperative pain. However, comparative evidence remains heterogeneous.
Methods:
This single-center retrospective cohort study included consecutive patients who underwent minimally invasive thymectomy between January 2019 and December 2023. Patients were assigned to the ICA or SA group according to the surgical approach performed. The primary outcome was early postoperative pain assessed using the visual analog scale (VAS) within 48 h. Secondary outcomes included operative and perioperative parameters, postoperative complications, and short-term follow-up outcomes. Multivariable linear regression analysis was conducted to adjust for potential confounders.
Results:
Of 168 patients assessed for eligibility, 90 were included in the final analysis (ICA, n = 48; SA, n = 42). Baseline characteristics were comparable between groups. Operative time, intraoperative blood loss, duration of chest drainage, length of hospital stay, and hospitalization costs did not differ significantly. Early postoperative pain was lower in the SA group, with significantly reduced VAS scores during the first 48 h. Postoperative complication rates were low and similar between approaches, with no perioperative mortality observed. Among patients with MG, short-term neurological improvement did not differ significantly. Multivariable analysis confirmed that the subxiphoid approach was independently associated with lower early postoperative pain.
Conclusions:
Intercostal and subxiphoid thoracoscopic thymectomy demonstrated comparable perioperative safety and short-term clinical outcomes in this cohort. The subxiphoid approach was associated with lower early postoperative pain, while other operative and recovery-related parameters were similar. These findings support individualized surgical decision-making rather than a universally superior approach.
