Tubeless uniportal subxiphoid thoracoscopic thymectomy via percutaneous suspension technique for anterior mediastinal masses

Abstract

Objective

We previously developed the percutaneous suspension technique to improve the anterior mediastinal exposure in minimally invasive thymectomy. In this study, we aimed to integrate this technique with tubeless video-assisted thoracoscopic surgery (VATS) for uniportal subxiphoid thoracoscopic thymectomy and to evaluate perioperative outcomes of this combined approach.

Methods

This retrospective, multicenter study included patients with anterior mediastinal masses who underwent uniportal subxiphoid thoracoscopic thymectomy using the percutaneous suspension technique combined with tubeless VATS at 4 centers between March and September 2025. Comprehensive early outcome data, including intraoperative and postoperative variables, were collected and analyzed.

Results

In total, 15 patients were included, with a median age of 53 years (range, 25-75 years). Median operative and anesthesia times were 83 minutes (range, 35-192 minutes) and 140 minutes (range, 108-264 minutes), respectively. The median pain score was 2 (range, 1-3) on postoperative day 1 and was 0 in all patients on postoperative day 7. The median postoperative length of stay was 2 days (range, 1-4 days). No conversions and no major intraoperative or postoperative complications occurred. 5 patients (33.3%) developed mild pneumothorax and 3 (20.0%) developed mild atelectasis, all managed conservatively without chest drain insertion. No patient required reinsertion of a chest drain or urinary catheter during hospitalization or after discharge.

Conclusions

Tubeless uniportal subxiphoid thoracoscopic thymectomy with the percutaneous suspension technique is safe and feasible for anterior mediastinal masses, although tubeless VATS potentially associated with a slightly higher incidence of minor complications.