Uniportal midline subxiphoid thymectomy: Our experience from a single oncology centre in India.

Abstract

Background: Thymoma is the most common anterior mediastinal neoplasm in adults and often requires surgical resection for curative treatment. Traditional approaches, including open surgery and multiportal thoracoscopic techniques, are associated with significant morbidity. The uniportal subxiphoid approach offers a minimally invasive, patient-friendly alternative, with potential benefits in operative efficiency and post-operative recovery. This technique may be particularly advantageous in low-resource settings, given its simplicity and reduced need for specialized equipment or personnel.

Methods: This study included 27 patients who underwent uniportal subxiphoid thymectomy at our institution between January 2022 and December 2024. The technique involves pre-operative planning based on tumour staging, with resections possible for tumours up to 15 cm. The patient is placed supine, with no carbon dioxide insufflation or epidural anaesthesia used. An incision below the xiphoid process provides access for tumour dissection, utilizing a thoracoscope. The thymoma is carefully removed through the incision, followed by a mediastinal drain placement.

Results: In 27 patients, tumour sizes ranged from 2 to 15 cm. The mean operative time was 106.9 min, with minimal blood loss (46.7 mL). All procedures were R0 resections, with no conversions to open surgery. Post-operative pain was minimal, and the mean hospital stay was 2.6 days.

Conclusions: The uniportal subxiphoid thymectomy is an effective, minimally invasive technique, offering excellent outcomes in terms of operative time, blood loss, and recovery. It provides a safe, efficient, and cost-effective alternative, especially for low-resource settings.