A clinical analysis on subxiphoid and intercostal video-assisted thoracoscopic extended thymectomy

Objective To explore the clinical characteristics of video-assisted thoracoscopic (VATS) extended thymectomy via subxiphoid and intercostal approaches. Methods Clinical data of consecutive VATS extended thymectomy performed between Jan. 2015 and Dec. 2018 in Department of Thoracic Surgery of Xuzhou Central Hospital was retrospectively analyzed. The patients were divided into intercostal multiple VATS (MVATS) group, subxiphoid MVATS group and subxiphoid uniportal VATS (UVATS) group. The operation-related parameters were compared respectively among the groups. Results There were 5 cases in the intercostal group and 7 cases in the subxiphoid groups suffered from myasthenia gravies (MG) before surgery. There was no short-term mortality, or conversion to thoracotomy. Three patients in subxiphoid UVATS group converted to subxiphoid MVATS. Besides, as compared with the subxiphoid MVATS and UVATS group, the patients of intercostal MVATS group revealed shorter operation time [(64.0±15.1) min vs (71.4±18.1) min vs (87.4±18.7) min, P< 0.05], shorter chest tube drainage [(1.5±0.7) d vs (2.3±1.1) d vs (2.9±1.3) d, P< 0.05], smaller drainage volume [(131.4±66.5) ml vs (169.9±110.6) ml vs (231.5±111.9) ml, P<0.05], shorter postoperative stay [(1.9±1.1) d vs (3.1±2.0) d vs (3.7±2.8) d, P< 0.05], but higher pain score on the first postoperative day [(4.2±1.3) vs (3.7±1.1) vs (3.5±1.2), P<0.05]. In addition, subxiphoid UVATS group reported two cases of MG crisis after surgery. Besides, incomplete resection of anterior mediastinal fat tissue was found in 1 case in the subxiphoid MVATS group and 5 cases in the UVATS group, as shown by computered tomography after surgery. Conclusions Subxiphoid VATS extended thymectomy is feasible, but it does not indicate significant advantages as compared with intercostal MVATS approach. Key words: Subxiphoid; Uniportal; Video-assisted thoracic surgery; Thymectomy