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Radical thymectomy using a bilateral thoracoscopic approach for stage 1 thymoma

The description of the video-assisted thoracoscopic thymectomy explains all aspects of the surgical procedure used for the management of anterior mediastinal tumors. This is the case of a 53-year-old patient with a past medical history of papillary carcinoma. A control CT-scan showed an anterior mediastinal tumor, morphologically in favor of a thymoma. Patient positioning and technical key steps of the surgical procedure are presented.

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Radical   thymectomy   using   a   bilateral   thoracoscopic   approach   for   stage   1   thymoma

作者群
D Gossot
摘要
The description of the video-assisted thoracoscopic thymectomy explains all aspects of the surgical procedure used for the management of anterior mediastinal tumors. This is the case of a 53-year-old patient with a past medical history of papillary carcinoma. A control CT-scan showed an anterior mediastinal tumor, morphologically in favor of a thymoma. Patient positioning and technical key steps of the surgical procedure are presented.
關鍵字
radical thymectomy, bilateral thoracoscopic approach, stage 1 thymoma, papillary carcinoma
媒體類型
期間
05'35''
刊物
2008-06
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, Jun 2008;8(06).
URL: http://www.websurg.com/doi-vd01en2324.htm

Radical   thymectomy   using   a   bilateral   thoracoscopic   approach   for   stage   1   thymoma

1. Case presentation 00'31''
This is the case of a 53-year-old patient, with a past medical history of a papillary thyroid carcinoma. On a control CT-scan, a 6x5cm tumor was found in the anterior mediastinum, morphologically in favour of a stage I thymoma. The patient didn’t have any symptoms at the moment of the diagnosis and the laboratory findings were normal. A bilateral thoracoscopic radical thymectomy is planned. The patient is positioned in a left semi-lateral position in order to free the healthy left thymus. As this step is symmetrical to the other, it is not shown here. Once the left thymus has been freed, a thoracic drain is placed and the patient is rotated to a right semi-lateral decubitus position. Only the right thymectomy (where the tumour is located) is shown in this video. The optical trocar is placed in the 5th intercostal space along the posterior axillary line. A 10mm operating trocar is placed in the 6th intercostal space along the anterior axillary line, and a 5mm trocar in the 4th intercostal space along the median axillary line. We begin the procedure by carefully examining the thorax. The major structural landmarks should be identified, including the superior vena cava, the brachiocephalic vein and the phrenic nerve. The arterial supply of the thymus originates laterally from branches of the internal mammary artery. We start dissection by opening the mediastinal pleura from the inferior pole of the thymic gland. Along with traction and counter-traction, the cleavage plane is found, resulting in a bloodless dissection with the aid of the ultrasonic scissors. As we continue dissecting; the thymus is bluntly dissected off the underlying pericardium, extending upward until the brachiocephalic vein is exposed. Vascular control should be obtained before further manipulation of the thymus. We then continue with what can be considered the most critical part of the procedure: that is dissection of the superior horns. With gentle inferior traction on the thymus, the superior pole is dissected to free it from its superior attachment. Dissection is then carried out behind the sternum. This can be performed with scissors or hook with monopolar cautery. The thymus is vascularized by 2 to 3 tributaries running to the left brachiocephalic vein. The venous tributaries draining into the brachiocephalic vein are identified, clipped and divided. The thymus is removed in a plastic bag through the most anterior trocar. Vital structures are identified and preserved: pericardium, superior vena cava, brachiocephalic vein, internal mammary vein. The pathological examination showed a complete resected specimen that confirmed our initial diagnosis.