Is it VATS the best approach for thymectomy?

We have seen many reports that address VATS as an effective way of doing thymectomy for thymomas. I was never very keen of doing VATS for removing a thymic tumor, as I don’t think I can get all mediastinal fat with this approach. The mediastinal dissection, at least in my hands, is just not the same.

When we do a thymectomy, we do it through a median sternotomy. With this approach we go from one phernic to the other and from the innominate vein and the upper thymic horns to the diaphragm getting all the pericardial fat out. There’s just no way I can achieve this with VATS. Unfortunately, I don’t have much experience with the Da Vinci, which I know can make a difference in this surgery.

Thymomas are slow growing tumors, many times are small and it might not even make much a difference if you don’t take all the mediastinal fat out; I’m not aware of any study that address differences between removing just the tumor with free margin vs. dissecting all the fat out. Anyway, I don’t feel from an oncological point of view, that removing just the tumor is the same.

We have a very good experience removing thymic tumor through median sternotomy, patients recover real fast with this approach and pain is usually not a big deal at all. And above all, we do believe is the right cancer operation for this patients.

Just to share a case with you, I showed above how it looks like after dissecting all the mediastinal fat out through median sternotomy for thymoma. I’m sure I can’t get the same result with VATS.

What are your thoughts?

Sebastian

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