Thoracoscopic resection of bulky thymoma assisted with artificial pneumothorax: A report of 19 consecutive cases

The aim of the present study was to examine the feasibility and efficacy of thoracoscopic radical resection of large retrosternal thymoma using artificial pneumothorax. A retrospective analysis was performed on 19 patients with bulky thymoma who underwent thoracoscopic resection using artificial pneumothorax by CO(2) insufflation. The operations were performed with unilateral or bilateral thoracic incisions via single lumen endotracheal intubation and two-lung ventilation. This approach provided excellent exposure of the thoracic cavity and reliable control of the neuro-vascular structures in the anterior mediastinum, which was of vital importance for the extended resection of malignant thymoma. The operation time was 140.0±51.4 min without conversion to thoracotomy or sternotomy. The pathological diagnosis was confirmed by immunohistochemistry, including 5 cases of thymus lipomyoma, 1 case of thymus hyperplasia, 1 case of thymus cyst, 2 cases of type AB thymoma, 4 cases of type B1 thymoma, 4 cases of type B3 thymoma, and 2 cases of thymic carcinoma. Furthermore, there were no complications such as recurrent laryngeal nerve injury, phrenic nerve injury, pulmonary infection or atelectasis, with a hospital stay of 5.0±3.0 days. In conclusion, the thoracoscopic resection of thymoma using artificial pneumothorax is a preferable approach, that may be considered for patients with bulky retrosternal tumors.