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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

A 4 cm length incision was performed at the level of the fourth intercostal among the anterior and middle axillary line (Part a). A well capsulated thymoma is visible (Part b). Thymic dissection is conducted parallel to left phrenic nerve (Part c). The left thyroid-thymic ligament is shown before its section (Part d). The "en bloc specimen consisting of thymus, peri-thymic and peri-cardiophrenic fatty tissue (Part e). Closure of left incision with a chest drainage (Part f)
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Fig2: A 4 cm length incision was performed at the level of the fourth intercostal among the anterior and middle axillary line (Part a). A well capsulated thymoma is visible (Part b). Thymic dissection is conducted parallel to left phrenic nerve (Part c). The left thyroid-thymic ligament is shown before its section (Part d). The "en bloc specimen consisting of thymus, peri-thymic and peri-cardiophrenic fatty tissue (Part e). Closure of left incision with a chest drainage (Part f)

Mentions: The patient was then placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space. The mediastinal pleura was dissected along the anterior border of the phrenic nerve. The thymus was mobilized to expose the thymic veins, the innominate vein and the thyroid-thymic ligaments. Then, the mediastinal fat was fully dissected from the phrenic nerve, the innominate vein, the aorto-pulmonary window, the aorto-caval groove, and the peri-cardiophrenic angle. After completing thymic dissection, the specimen was retrieved through the same incision and a chest tube was then inserted. Figure 2 summarized the left side procedure. 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). At 18 months of follow-up, the patient did not present recurrence. The main steps of the procedure are summarized in Additional file 1: Video 1.Fig. 2


Bilateral single-port thoracoscopic extended thymectomy for management of thymoma and myasthenia gravis: case report
A 4 cm length incision was performed at the level of the fourth intercostal among the anterior and middle axillary line (Part a). A well capsulated thymoma is visible (Part b). Thymic dissection is conducted parallel to left phrenic nerve (Part c). The left thyroid-thymic ligament is shown before its section (Part d). The "en bloc specimen consisting of thymus, peri-thymic and peri-cardiophrenic fatty tissue (Part e). Closure of left 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

Fig2: A 4 cm length incision was performed at the level of the fourth intercostal among the anterior and middle axillary line (Part a). A well capsulated thymoma is visible (Part b). Thymic dissection is conducted parallel to left phrenic nerve (Part c). The left thyroid-thymic ligament is shown before its section (Part d). The "en bloc specimen consisting of thymus, peri-thymic and peri-cardiophrenic fatty tissue (Part e). Closure of left incision with a chest drainage (Part f)
Mentions: The patient was then placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space. The mediastinal pleura was dissected along the anterior border of the phrenic nerve. The thymus was mobilized to expose the thymic veins, the innominate vein and the thyroid-thymic ligaments. Then, the mediastinal fat was fully dissected from the phrenic nerve, the innominate vein, the aorto-pulmonary window, the aorto-caval groove, and the peri-cardiophrenic angle. After completing thymic dissection, the specimen was retrieved through the same incision and a chest tube was then inserted. Figure 2 summarized the left side procedure. 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). At 18 months of follow-up, the patient did not present recurrence. The main steps of the procedure are summarized in Additional file 1: Video 1.Fig. 2

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