Original Article
Transcervical thymectomy
Abstract
Background: The aim of this article is to describe the technique of minimally invasive extended thymectomy performed through the transcervical video-thoracoscopic (VATS) approach with elevation of the sternum for the thymic tumors with/without myasthenia gravis (MG).
Methods: The operation is done through the collar incision in the neck of a length of 4–8 cm. To facilitate an access to the mediastinum a one-tooth hook connected to the Zakopane bar (Aesculap-Chifa, Nowy Tomysl, Poland) is inserted under the sternal notch for elevation of the sternum. Careful anatomical dissection of the structures of the lower neck region is done with preservation from injury of the thyroid gland, the parathyroid glands and both laryngeal recurrent nerves. The thymus gland is resected en-bloc with the surrounding fatty tissue of the lower neck and the anterior superior mediastinum. The blood vessels supplying the thymus are secured and divided—these are inferior thyroid veins and the thymic veins. For better control, a video-thoracoscope (VATS) is inserted to the mediastinum through the cervical incision. The lowers poles of the thymus are separated from the pericardium and the specimen is removed. Usually, the right lower pole is dissected first and the left lower pole is managed during further dissection of the aortopulmonary window is a difficult, but very important part of transcervical thymectomy.
Results: There were 18 patients (2 for MG with associated thymic tumors and 16 for the tumors/cysts of the anterior mediastinum without MG) in the period 1/1/2009 to 31/12/2017. The morbidity was 5.6%, with no mortality. The mean time of the procedure was 105.4 min (45–150 min).
Conclusions: The transcervical approach combined with VATS and lifting of the sternum facilitates thymectomy in case of small thymic tumors with/without MG. This technique is more difficult and less extensive that subxiphoid thymectomy.
Methods: The operation is done through the collar incision in the neck of a length of 4–8 cm. To facilitate an access to the mediastinum a one-tooth hook connected to the Zakopane bar (Aesculap-Chifa, Nowy Tomysl, Poland) is inserted under the sternal notch for elevation of the sternum. Careful anatomical dissection of the structures of the lower neck region is done with preservation from injury of the thyroid gland, the parathyroid glands and both laryngeal recurrent nerves. The thymus gland is resected en-bloc with the surrounding fatty tissue of the lower neck and the anterior superior mediastinum. The blood vessels supplying the thymus are secured and divided—these are inferior thyroid veins and the thymic veins. For better control, a video-thoracoscope (VATS) is inserted to the mediastinum through the cervical incision. The lowers poles of the thymus are separated from the pericardium and the specimen is removed. Usually, the right lower pole is dissected first and the left lower pole is managed during further dissection of the aortopulmonary window is a difficult, but very important part of transcervical thymectomy.
Results: There were 18 patients (2 for MG with associated thymic tumors and 16 for the tumors/cysts of the anterior mediastinum without MG) in the period 1/1/2009 to 31/12/2017. The morbidity was 5.6%, with no mortality. The mean time of the procedure was 105.4 min (45–150 min).
Conclusions: The transcervical approach combined with VATS and lifting of the sternum facilitates thymectomy in case of small thymic tumors with/without MG. This technique is more difficult and less extensive that subxiphoid thymectomy.
