INITIAL RESULTS OF LAPAROSCOPIC SINGLE-PORTION THYMECTOMY THYROIDECTOMY VIA SUPERHIZONTAL INCISION
Main Article Content
Abstract
Objectives: To evaluate the feasibility and early outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for thymectomy in the treatment of myasthenia gravis and thymic tumors at Bach Mai Hospital.
Materials and Methods: A prospective case series study was conducted on patients indicated for subxiphoid uniportal VATS thymectomy at the Department of Thoracic Surgery, Bach Mai Hospital, from December 2024 to November 2025. Clinical indicators, histopathological characteristics, and early postoperative results were collected and analyzed.
Results: From December 2024 to November 2025, 39 patients (29 females and 10 males) underwent subxiphoid uniportal video-assisted thoracoscopic surgery thymectomy at Bach Mai Hospital. The mean age was 51.2 ± 13.1 years; 34 patients had myasthenia gravis (87.2%). The mean tumor size was 2.9 ± 1.2 cm. Histopathological results showed 7 cases of thymic hyperplasia (17.9%), 4 cases of benign thymic cysts (9.8%), and 28 cases of thymoma (71.8%), including: 2 cases of type A (7.1%), 9 cases of type AB (32.1%), 2 cases of type B1 (7.1%), 11 cases of type B2 (39.3%), and 4 cases of type B3 (14.3%). The mean operative time was 101.4 ± 23.8 minutes (range: 70–160 minutes). One case of intraoperative innominate vein injury occurred, but no conversion to open surgery was required. The mean chest tube duration was 2.1 ± 0.9 days, and the mean hospital stay was 5.0 ± 4.3 days. No patients experienced phrenic nerve palsy. Postoperative complications included one patient with pneumothorax requiring chest tube re-insertion and two patients with postoperative myasthenic crisis.
Conclusions: Subxiphoid uniportal VATS thymectomy is a safe and feasible technique for the treatment of myasthenia gravis and thymic tumors, yielding promising early outcomes at a specialized surgical center.
Article Details
Keywords
Thymic adenoma, myasthenia gravis, single-port endoscopic surgery, subxiphoid process.
References
[2] Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg. 2020;58(Suppl_1):i44-i49. doi:10.1093/ejcts/ezaa183
[3] Chen H, Xu B, Zhang Q, Chen P et al. Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach. Turk Gogus Kalp Damar Cerrahisi Derg. 2023;31(2):239-248. doi:10.5606/tgkdc.dergisi.2023.23455
[4] Yu L, Zhang X jun, Ma S et al. Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: a single-center experience. Ann Thorac Surg. 2012;93(1):240-244. doi:10.1016/j.athoracsur.2011.04.043
[5] Lê Thị Thiên Nga, Hồ Tất Bằng, Nguyễn Đình Phát et al. Kết quả bước đầu phẫu thuật nội soi lồng ngực cắt tuyến ức có kết hợp đường mổ dưới mũi ức. Tạp chí Y học Việt Nam. 2022;520(2):2. doi:10.51298/vmj.v520i2.4125
[6] Masaoka A. Staging System of Thymoma. Journal of Thoracic Oncology. 2010;5(10):S304-S312. doi:10.1097/JTO.0b013e3181f20c05
[7] Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized Trial of Thymectomy in Myasthenia Gravis. N Engl J Med. 2016;375(6):511-522. doi:10.1056/NEJMoa1602489
[8] Perlo VP, Poskanzer DC, Schwab RS et al. Myasthenia gravis. Neurology. 1966;16(5):431-431. doi:10.1212/WNL.16.5.431
[9] Dresser L, Wlodarski R, Rezania K et al. Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations. Journal of Clinical Medicine. 2021;10(11):11. doi:10.3390/jcm10112235
[10] Zhang L, Li M, Jiang F et al. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis. International Journal of Surgery. 2019;67:13-17. doi:10.1016/j.ijsu.2019.01.011
[11] Detterbeck FC. Clinical Value of the WHO Classification System of Thymoma. The Annals of Thoracic Surgery. 2006;81(6):2328-2334. doi:10.1016/j.athoracsur.2005.11.067
[12] Tomiyama N, Johkoh T, Mihara N, et al. Using the World Health Organization Classification of Thymic Epithelial Neoplasms to Describe CT Findings. American Journal of Roentgenology. 2002;179(4):881-886. doi:10.2214/ajr.179.4.1790881
[13] Suda T. Subxiphoid thymectomy: single-port, dual-port, and robot-assisted. J Vis Surg. 2017;3:75. doi:10.21037/jovs.2017.05.07
[14] Jiang JH, Gao J, Zhang Y et al. Modified Subxiphoid Thoracoscopic Thymectomy for Locally Invasive Thymoma. Ann Thorac Surg. 2021;112(4):1095-1100. doi:10.1016/j.athoracsur.2020.10.032
[15] Wang H, Wang M, Xin N et al. Effect Evaluation of Subxiphoid and Intercostal Thymectomy: A Meta-Analysis and Systematic Review. Front Surg. 2022;9:925003. doi:10.3389/fsurg.2022.925003
[16] Rabiou S, Toudou-Daouda M, Lakranbi M et al. Outcomes after Thymectomy in Patients with Thymomatous Myasthenia Gravis. J Neurosci Rural Pract. 2022;13(2):321-325. doi:10.1055/s-0042-1743444
[17] Aljaafari D, Ishaque N. Thymectomy in Myasthenia Gravis: A Narrative Review. Saudi J Med Med Sci. 2022;10(2):97-104. doi:10.4103/sjmms.sjmms_80_22