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OBJECTIVE: Complete thymectomy requires removal of the thymus from one phrenic nerve to the other, including the thyro-thymic horns and all pericardial fat, Various methods of thymectomy that avoid sternotomy have been described. With the cervical approach, visualization is usually not adequate. The thoracosopic approach requires bilateral chest incisions, and uses 2D imaging with non-articulating instruments. Robotic assistance allows 3D imaging using articulating instruments, with no haptic feedback and requires bilateral chest incisions with longer procedural times and greater expense. We have adopted asimplified approach via an anterolateral left mini thoracotomy that allows complete thymectomy under direct visualization
METHODS: We evaluated the short term outcome of patients underwent minimal invasive thymectomy via left anterior mini-thoracotomy between 2011and 2014.The surgical technique involved p 5 cm incision in the infra mammary crease. The chest was entered through the 4th intercostal space. A special designed retractor was put in with the upper blade providing lift of the chest wall. Single lung ventilation was used. Excellent visualization of the thymus and the left phrenic nerve was obtained. The right pleural cavity was opened widely. The right phrenic nerve could be seen. This allowed to create an incision line that was just anterior to the phrenic nerve on both sides, sweeping away all the pericardial fat and the rest of the thymus going from inferior to superior. The innominate vein was skeletonized and tributaries draining into it were clipped and divided. The thyro-thymic tracts constituting the horns of the thymus gland were also dissected out above the innominate vein and the entire specimen was removed.
RESULTS: Refer to the result table
CONCLUSIONS: For minimally invasive thymectomy, the cervical and subxiphoid approaches have suboptimal visualization of the entire thymus. (VAT) and (RAT) are expensive, takes longer time, carry more risk of complication and involves multiple incisions. The incision size is relatively equal to the incision size or the RAT or VAT. It allows excellent visualization and tactile feedback.