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Bilateral single-port thoracoscopic extended thymectomy for management of thymoma and myasthenia gravis: case report

View Article: PubMed Central - PubMed

ABSTRACT

Background: Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach.

Case presentation: A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I). No recurrence was found at 18 months of follow-up

Conclusions: Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over traditional technique. Obviously, our impression should be validated by larger studies in terms of long-term oncological outcomes.

Electronic supplementary material: The online version of this article (doi:10.1186/s13019-016-0547-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

The chest computed tomography scan showed a 3,5 cm thymoma (Part a). Patient was placed in left lateral decubitus position, with the surgeon and the assistant standing on the posterior side (Part b). Dissection was landmarked by the superior border of phrenic nerve (Part c). The thymus was retracted superiorly and medially; the superior vena cava and the ascending aorta were skeletonised (Part d). Right side thymic and perithymic fatty tissue dissection was completed and left lung visible (Part e). Closure of right incision with a chest drainage (Part f)
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Fig1: The chest computed tomography scan showed a 3,5 cm thymoma (Part a). Patient was placed in left lateral decubitus position, with the surgeon and the assistant standing on the posterior side (Part b). Dissection was landmarked by the superior border of phrenic nerve (Part c). The thymus was retracted superiorly and medially; the superior vena cava and the ascending aorta were skeletonised (Part d). Right side thymic and perithymic fatty tissue dissection was completed and left lung visible (Part e). Closure of right incision with a chest drainage (Part f)

Mentions: Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus with a roll placed under the shoulder and the ipsilateral arm wrapped by a sterile stockinet and maintained parallel to the body. A 3 cm skin incision was performed in the fourth right intercostal space and through that a 30° camera and working instruments were inserted without rib spreading. The dissection started from the peri-cardiophrenic angle and continued cranially along the anterior border of the phrenic nerve. The thymus was then mobilized from the surrounding fat tissue and vena cava. Following, the contralateral pleura was opened, and, through that the thymus was pushed into the left pleural cavity. A single 24 fr chest tube was inserted through the same incision within right costo-phrenic angle. Figure 1 summarized the right side procedure.Fig. 1


Bilateral single-port thoracoscopic extended thymectomy for management of thymoma and myasthenia gravis: case report
The chest computed tomography scan showed a 3,5 cm thymoma (Part a). Patient was placed in left lateral decubitus position, with the surgeon and the assistant standing on the posterior side (Part b). Dissection was landmarked by the superior border of phrenic nerve (Part c). The thymus was retracted superiorly and medially; the superior vena cava and the ascending aorta were skeletonised (Part d). Right side thymic and perithymic fatty tissue dissection was completed and left lung visible (Part e). Closure of right incision with a chest drainage (Part f)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120463&req=5

Fig1: The chest computed tomography scan showed a 3,5 cm thymoma (Part a). Patient was placed in left lateral decubitus position, with the surgeon and the assistant standing on the posterior side (Part b). Dissection was landmarked by the superior border of phrenic nerve (Part c). The thymus was retracted superiorly and medially; the superior vena cava and the ascending aorta were skeletonised (Part d). Right side thymic and perithymic fatty tissue dissection was completed and left lung visible (Part e). Closure of right incision with a chest drainage (Part f)
Mentions: Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus with a roll placed under the shoulder and the ipsilateral arm wrapped by a sterile stockinet and maintained parallel to the body. A 3 cm skin incision was performed in the fourth right intercostal space and through that a 30° camera and working instruments were inserted without rib spreading. The dissection started from the peri-cardiophrenic angle and continued cranially along the anterior border of the phrenic nerve. The thymus was then mobilized from the surrounding fat tissue and vena cava. Following, the contralateral pleura was opened, and, through that the thymus was pushed into the left pleural cavity. A single 24 fr chest tube was inserted through the same incision within right costo-phrenic angle. Figure 1 summarized the right side procedure.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach.

Case presentation: A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I). No recurrence was found at 18 months of follow-up

Conclusions: Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over traditional technique. Obviously, our impression should be validated by larger studies in terms of long-term oncological outcomes.

Electronic supplementary material: The online version of this article (doi:10.1186/s13019-016-0547-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus