VATS thymectomy—bilateral approach for extended resection

Various bilateral VATS thymectomy procedures were introduced in the 1990’s, of which a bilateral VATS extended thymectomy has an advantage of confirming the bilateral phrenic nerves and seems to be the most conventional method in use. Soon after introduction of the method, an anterior cervical incision approach was added, because peri-thymic tissues are thought to reside mostly around the upper poles of the thymus. Studies have shown that significant amounts of thymic and peri-thymic tissues are left behind without use of a cervical incision. Later, several additional techniques, including elevation of the sternum, division of the right internal thoracic vein, and CO₂ insufflation, served to make a cervical incision unnecessary and also providing a cosmetic advantage. Nevertheless, this procedure is still thought to be more invasive than a unilateral approach in terms of longer procedure time and bilateral thoracic incision. Recently, a uniportal bilateral approach was reported and advancement to a reduced port might be a means for achieving a less invasive approach for a bilateral VATS extended thymectomy.