The video-assisted thoracoscopic thymectomy is presented here using a 3-port technique with CO2 insufflation. During operations on the mediastinum, CO2 insufflation significantly facilitates layer-specific dissection, so trocars with appropriate valves and gas connections, as used in visceral surgery. The first access is created via a mini-incision in the area of approximately the 5th intercostal space, anterior axillary line, in extension of the inframammary fold. The placement of the 2 additional incisions should only be performed after inspection of the site. There are various possibilities here. Usually, a trocar in the 3rd intercostal space in the anterior axillary line and another a few centimeters ventral to the first trocar in the same intercostal space are suitable for the additional accesses. Alternatively, a substernal trocar is also possible, which can be more easily expanded for later retrieval in the case of larger tumors.
Note:
- The thoracoscopic thymectomy can be performed from the left as shown here. Alternatively, access from the right or subxiphoidally is also possible.
- Especially in obese patients, CO2 insufflation can be advantageous.