The Outcomes of Subxiphoid Thoracoscopic Versus Video-Assisted Thoracic Surgery for Thymic Diseases

Objectives: The subxiphoid thoracoscopic approach may be an alternative to the lateral transthoracic approach in the treatment of thymic diseases. This study aimed to assess the safety and efficacy of subxiphoid video-assisted thoracoscopic surgery and compare this approach with the lateral transthoracic variation in terms of short-term perioperative outcomes. Methods: Data for 107 consecutive adult patients who underwent transthoracic or subxiphoid video-assisted thoracic surgery for thymic diseases from July 2015 to February 2019 were retrospectively reviewed. The patients were stratified according to whether they had accompanying myasthenia gravis (MG). Perioperative outcomes were compared between the two cohorts. Results: A total of 107 patients were identified, including 37 patients who underwent subxiphoid video-assisted thoracoscopic thymectomy (S-VATT) and 70 patients who underwent transthoracic video-assisted thoracoscopic thymectomy (T-VATT). The S-VATT group exhibited less operative blood loss (112.14 ± 117.01 versus 58.81 ± 48.67, P = .003), a shorter duration of chest tube usage (3.77 ± 1.83 versus 2.18 ± 1.88, P = .000), lower postoperative pain scores (4.99 ± 0.99 versus 1.57 ± 0.55, P = .000), and a shorter length of postoperative hospital stay (5.83 ± 1.38 versus 4.38 ± 1.26, P = .000) than the T-VATT group. For MG patients, the median operative time was significantly shorter in the S-VATT group than in the T-VATT group (141.46 ± 54.17 versus 95.63 ± 31.25, P = .004). Conclusions: S-VATT is a safe approach for patients with thymic diseases and has potential advantages of a shorter operative time, less intraoperative bleeding, and less postoperative pain compared with the lateral transthoracic approach, especially for patients with MG.