title: Video-assisted thymectomy with contralateral surveillance camera: a means to minimize the risk of contralateral phrenic nerve injury.
abstract: OBJECTIVE
  Thymectomy for thymoma has traditionally been performed through midsternotomy that provides excellent exposure for a complete and safe resection. Minimally invasive alternatives have not been extensively evaluated for this disease process because data regarding the long-term oncologic effectiveness of these techniques remain to be established. Furthermore, video-assisted surgery as a unilateral approach may compromise the extension of the resection and could cause irreversible damage to the phrenic nerve of the opposite side. We evaluated the clinical feasibility and safety of a bilateral concomitant video-assisted approach with contralateral surveillance camera in patients undergoing thymectomy for thymoma.
  
  
  METHODS
  Four patients (3 females, 1 male) with thymoma causing myasthenia gravis (MG) were operated thoracoscopically at our institute under general anesthesia with double-lumen endotracheal intubation. The patients were placed in a supine position, and a 5-mm 30-degree lens thoracoscope was introduced into the left pleural space. Two other 10-mm working channels were applied. En bloc thymectomy was then performed, including mediastinal and pericardial fat pads, other tissue, and pleura from the level of the thoracic inlet to the diaphragm. A second 5-mm thoracoscope was inserted into the right hemithorax, and it was kept inside during the entire procedure to allow lateral surveillance of the extension and safety of the resection. Carbon dioxide insufflation and valved ports were used.
  
  
  RESULTS
  The duration of the operation was 90 ± 72 minutes. Complete resection was achieved in all patients without any nerve injury. There were no perioperative adverse events. Gradual remission from extremity and ocular weakness was achieved after recovery.
  
  
  CONCLUSIONS
  The ultimate surgical goal of thymectomy is to completely remove the gland and anterior mediastinal tissue without nerve injury. Bilateral concomitant video-assisted thoracic thymectomy with a contralateral surveillance camera was found feasible and safe. Given the capability of our technique to perform a complete and extensive thymectomy associated with less invasiveness and beneficial effects, there seems to be a role for minimally invasive thymectomy in the treatment of thymoma.
authors.affiliation: Departments of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. nesher61@gmail.com
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.forename: Dmitry
authors.initials: D
authors.lastname: Pevni
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.forename: Amir
authors.initials: A
authors.lastname: Kramer
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
authors.forename: Gideon
authors.initials: G
authors.lastname: Uretzky
authors.forename: Yanai
authors.initials: Y
authors.lastname: Ben-Gal
authors.forename: Yosef
authors.initials: Y
authors.lastname: Paz
mesh_terms: D002245:Carbon Dioxide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D009157:Myasthenia Gravis / Q000150:complications*; D017060:Patient Satisfaction; D010791:Phrenic Nerve; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000175:diagnosis / Q000601:surgery*; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide