SUBXIPHOID UNIPORTAL VATS NON-INTUBATEDTHYMECTOMIESVS INTUBATED THYMECTOMIES
MARIA NIZAMI, Raisa Bushra, John Hogan, Luke Williams, Adam Peryt, Aman Coonar, Giuseppe Aresu.
Royal Papworth Hospital, Cambridge, United Kingdom.
BACKGROUND: Subxiphoid video-assisted-thoracoscopic-surgery (SVATS) has been associated with enhanced recovery and shorter length of hospital stay. This retrospective comparative study is aimed to compare the technical feasibility, safety and adequacy of oncological resection in patients undergoing non-intubated SVATS thymectomy and who underwent a traditional intubated subxiphoid resection. METHODS: We conducted a retrospective study of 42 patients who underwent Subxiphoid VATS thymectomy from September 2016 until June 2021. 21 carefully-selected patients underwent non-intubated SVATS thymectomy. In total 42 patients were selected for the study and were matched with regards to age, gender, comorbidities, smoking-history, and length of hospital stay.There were no deaths in both groups after a year.Additionally, pain scores were measured post-operatively in 1,3,6 months and in one year.Non-intubated SVATS was performed with spontaneous breathing maintained throughout the operation with air/sevoflurane. Additionally,several nerve blocks were employed including intercostal and paravertebral to maintain analgesia and diaphragm control.
RESULTS: In Group1 only 19% of the patients experienced mild pain after 1 month follow up, compared to 33% in Group2. Similar results were reported up to one year follow up. Post-operative complications, In Group2, there were 3 cases converted to sternotomy, compared to Group1, where only in one case, the incision was extended to a mini sternotomy. Subsequently, there were two admissions to the Intensive Care Unit for Group2 and one admission due to AKI for Group1. The median hospital length of stay for both groups was 2 days and 30day survival for both groups was 100%. (Table 1). Histology demonstrated thymoma tumors were resected in 8 cases (38%) in Group1 compared to 14 in Group2.All malignant cases were pathologically N0. Complete resection was achieved in all cases in Group1 whereas in Group 2,4 cases were reported with R1 resection margin.
CONCLUSIONS: Significant improvements in pain management were reported post-operatively,and most of the patients in the non-intubated SVATS group were back to their baseline performance status on discharge.Based on our experience of Non intubated subxiphoid thymectomy is safe and associated with adequate oncological resection.However, larger studies are required to confirm this hypothesis. 
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