The Safety and Feasibility of Laryngeal Mask Airway Management in Nonintubated Subxiphoid-Subcostal Thoracoscopic Thymectomy: Preliminary Results

While intubated general anesthesia with single-lung ventilation is regarded as mandatory for conventional thoracoscopic surgery, and various minimally invasive approaches to thymectomy have been described, nonintubated thoracoscopic thymectomy remains technically challenging. This study reports the initial results of nonintubated subxiphoid-subcostal thoracoscopic thymectomy (NI-STT) under laryngeal mask airway management for patients with thymic tumor or myasthenia gravis (MG), and evaluates the feasibility and safety of the procedure.

A retrospective analysis was performed on 61 consecutive patients who underwent NI-STT for thymic tumor or MG at our department from January 2021 to January 2024. The clinical characteristics, perioperative parameters, and early surgical outcomes of the patients were reviewed and analyzed.

Among the 61 patients, 19 with MG underwent an extended thymectomy, and the remaining 42 underwent partial thymectomy. The mean anesthetic induction duration, surgical duration, and global operating room duration were 24.8 ± 12.3 min, 118.8 ± 32.5 min, and 173.5 ± 41.8 min, respectively. The lowest pulse oxygen saturation and peak end-tidal carbon dioxide during operation were 96.2% ± 2.9% and 41.8 ± 7.5 mm Hg, respectively. One patient required conversion to intubated anesthesia because of hypercapnia with persistent hypoxia, and one required conversion to sternotomy owing to dense mediastinal adhesions. The mean duration of chest drainage and postoperative hospital stays were 1.9 ± 0.7 d and 2.9 ± 0.7 d, respectively. Postoperative complications included sore throat with irritable cough (n = 3), nausea and vomiting (n = 2), pneumonia (n = 2), wound infection (n = 1), and atrial fibrillation (n = 1); no phrenic nerve paralysis or mortality occurred. Visual analog scale pain scores on postoperative days 1, 3, 7, 14, 30, 90, and 180, were 4.5 ± 0.9, 2.6 ± 0.8, 1.1 ± 0.4, 0.6 ± 0.3, 0.4 ± 0.2, 0.2 ± 0.2, and 0.2 ± 0.1, respectively.

NI-STT performed under laryngeal mask airway management with controlled mechanical ventilation is a technically safe and feasible for selected patients with thymic tumors or MG and may serve as an alternative to conventional intubated approaches.