We performed a thoracoscopic extended thymothymectomy on a patient, a man in his forties, with a thymoma accompanied by a slightly elevated anti-Ach receptor antibody (0.5nmol/L, normal range <0.2) level without symptoms of myasthenia gravis. Here, we report the surgical method, focusing on its technique.
First, the patient was placed in a left semi-lateral position under general anesthesia using a double-lumen tube. Then, the thymic tumor was removed, and thymic tissue was detached from the anterior mediastinum and inferior pole of the thymus on the right side via three-port-thoracoscopic surgery in the right chest wall. Next, the thymic tissue from the bilateral inferior poles of the thyroid gland to the superior mediastinum was detached by pushing the upper mediastinal organs using cotton swabs. After turning the patient over, we then detached the left-side thymic tissue through four ports. Finally, the thymus, including the anterior mediastinal fat, was removed under thoracoscopic view. The surgical procedure was completed in 5h, with hemorrhage less than 50g.
The postoperative pathological diagnosis was invasive thymoma, type B1. There was little postoperative pain due to the port sites. The postoperative course was uneventful and the patient was discharged five days after surgery.