P14: Feasibility of “subxiphoid and subcostal” approach in video-assisted thoracoscopic thymectomy for patients with myasthenia gravis

Background: To investigate the safety and feasibility of the subxiphoid and subcostal approach in video-assisted thoracoscopic (VATS) extended thymectomy for patients with myasthenia gravis (MG).

Methods: Clinical data of 45 eligible patients who underwent VATS extended thymectomy for MG in our department from April 2014 to June 2015 by the same surgical team were retrospectively analyzed. Twenty five through right chest cases (group A), placed in the 30° left lateral decubitus position, were made three 5 to 10 mm incisions on the right chest. The en bloc dissection of thymus and perithymic and pericardiophrenic fatty tissue was achieved under the condition of general anesthesia with trachea double catheter insertion and one-lung ventilation. Twenty subxiphoid and subcostal cases (group B), placed in the type supine position, were made a 15 mm subxiphoid thoracoscope incision and two 5 mm operation incisions at the intersection point of bilateral midclavicular line and subcostal margin and resected the thymus and adipose tissue in the middle of bilateral phrenic nerve under the condition of general anesthesia, with trachea single catheter insertion and artificial pneumothorax. Retrospective analysis the clinical data of the two groups.

Results: All the surgeries were finished successfully without conversion to open thoracotomy. There were no significant differences between the two groups in operation time and the length of postoperative hospital stay [operation time: group A (139.5±39.7) min, group B (136.1±51.7) min; postoperative hospital stay: group A (10.2±17.5) d, group B (3.8±1.1) d; P>0.05]. The amount of blood loss and thoracic drainage periods in group B were less than group A [amount of blood loss: group A (138.8±123.0) mL, group B (66.5±42.8) mL; thoracic drainage periods: group A (1.7±1.0) d, group B (1.0±0.4) d; P<0.05].

Conclusions: This procedure offers the advantage of good surgical access for dissection around the bilateral phrenic nerves in extended thymectomy. It is more easily for surgeons to fully reveal the left phrenic nerve and the upper thymic poles.

Keywords: Subxiphoid; thoracoscopic; extended thymectomy