Lateral versus subxiphoid thoracoscopic thymectomy for nonthymomatous myasthenia gravis

Background: Video-assisted thoracoscopic thymectomy, performed using the intercostal approach lateral video-assisted thoracoscopic (LVATS), is the most widely used minimally invasive surgical treatment for thymus surgery worldwide. Subxiphoid single-port thoracoscopic thymectomy (SVATS) is a recent alternative approach to LVATS. Patients and Methods: Between May 2019 and February 2023, 60 patients with nonthymomatous myasthenia gravis were enrolled in this prospective study. Patients were randomly divided into two groups: (the LVATS group and the SVATS group); each group contained 30 patients. The mean operative time, blood loss, conversion to open thymectomy, duration of postoperative pleural drain, total length of hospital stay, and postoperative complications were evaluated. Results: The mean age was 37.3 +/- 5.61 in the LVATS group, while it was 39.7 +/- 6.39 in the SVATS group. The mean operating times were 94.66 +/- 14.31 min in the LVATS group and 90.56 +/- 10.80 min in the SVATS group, with no significant difference, observed (P=0.227). The LVATS group had a significant drop in hemoglobin level (1.86 +/- 0.77 gm%) compared with the SVATS group (1.31 +/- 0.46 gm%) (P=0.014). The mean duration of chest drains was significantly longer in the LVATS group (2.03 +/- 0.18 days) compared with the SVATS group (1.70 +/- 0.46 days) (P=0.001). The mean duration of postoperative pain was significantly longer in the LVATS group (8.36 +/- 0.80 days) compared with the SVATS group (6.16 +/- 1.14 days) (P=0.018). The mean total length of hospital stay was significantly longer in the LVATS group (12.46 +/- 0.73days) compared with the SVATS group (11.06 +/- 0.58 days) (P=0.003). Conclusion: Both LVATS and SVATS are safe and effective procedures for treatment of nonthymomatous myasthenia gravis. SVATS provides less intraoperative blood loss and a shorter duration of pleural drain, hospital stay, and postoperative pain.