title: Bilateral single-port thoracoscopic extended thymectomy for management of thymoma and myasthenia gravis: case report.
abstract: BACKGROUND
  Video-assisted thoracoscopy is become a widely accepted approach for the resection of anterior mediastinal masses, including thymoma. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Herein, we reported an extended resection of thymoma in a patient with myasthenia gravis through an uniportal bilateral thoracoscopic approach.
  
  
  METHODS
  A 74 years old woman with myasthenia gravis was referred to our attention for management of a 3.5 cm, well capsulate, thymoma. All laboratory and cardio-pulmonary tests were within normal; thus, she was scheduled for thymoma resection through an uniportal bilateral thoracoscopic approach. Under general anaesthesia and selective intubation, the patient was placed in a 60° right lateral decubitus. A 3 cm skin incision was performed in the fourth right intercostal space and, through that a 30° video-camera and working instruments were inserted without rib spreading. After complete dissection of the thymus and mediastinal fat, the contralateral pleura was opened, and, through that the specimen was pushed into the left pleural cavity. Then, the patient was placed in the left lateral decubitus. Similarly to the right side procedure, a 3-cm incision was performed in the fourth left intercostal space to complete thymic dissection and retrieve the specimen. No intraoperative and post-operative complications were found. The patient was discharged four days later. Pathological examination revealed a type A thymoma (Masaoka stage I). No recurrence was found at 18 months of follow-up CONCLUSIONS: Bilateral single-port thoracoscopy is an available procedure for management of thymoma associated with myasthenia gravis. The less post-operative pain, the reduction of hospital stay and the better esthetic results are all potential advantages of this approach over traditional technique. Obviously, our impression should be validated by larger studies in terms of long-term oncological outcomes.
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Caronia
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, I-80138, Naples, Italy. alfonso.fiorelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Arrigo
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Trovato
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia, 2, I-80138, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
authors.affiliation: Department of Surgery, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Attilio Ignazio Lo
authors.initials: AI
authors.lastname: Monte
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000150:complications / Q000601:surgery*; D013953:Thymus Neoplasms / Q000150:complications / Q000601:surgery*
keywords: Bilateral; Case report; Myasthenia gravis; Thoracoscopy; Thymoma; Uniportal