Thoracoscopic Thymectomy

Thymic pathology is conventionally approached through incisions such as thoracotomy, median sternotomy, or more limited access such as cervicotomy and partial sternotomy. Progress in videoendoscopic techniques have allowed the possibility of thoracoscopic treatment of thymic diseases. Adequate enclosure of the specimen within a plastic bag prevents tumor spilling. From September 1991 to March 1997, of 91 patients with mediastinal pathology, 50 underwent thoracoscopic excision of a mediastinal mass, including 22 patients with noninvasive stage I thymoma, 11 with myasthenia gravis, and 5 with a thymic cyst. The postoperative course was uneventful. Analysis of this data allows the following conclusions: (1) Benign pathology is most amenable to a thoracoscopic approach. (2) Videoendoscopy ensures optimal exposure of the mediastinum, safe and complete bilateral dissection of the thymus as well as the surrounding tissues. Preliminary results of videoendoscopic thymectomy for myasthenia gravis and for noninvasive stage I thymoma suggest this may be the treatment of choice. Further data and larger series are needed to evaluate long-term results.