Clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic thymectomy using a double sternum retractor versus conventional approaches

Background: The treatment of anterior mediastinal masses primarily utilizes video-assisted thoracoscopic surgery (VATS) thymectomy. This study introduced a subxiphoid uniportal VATS thymectomy (SUVT) using a double sternum retractor without artificial pneumothorax and compared its efficacy and safety to traditional VATS thymectomy (non-SUVT group). Methods: Patients diagnosed with anterior mediastinal masses who underwent the VATS thymectomy in West China Hospital, Sichuan University from June 2023 to May 2024 were included. We utilized the double sternum retractor to elevate the sternum in the SUVT group. The clinicopathologic features and perioperative outcomes of patients were assessed. The Visual Analog Scale (VAS) pain score was used to evaluate postoperative pain. Results: A total of 133 patients underwent the VATS thymectomy, including 41 SUVTs. The mass size was significantly larger in the SUVT group compared to the non-SUVT group (5.18 +/- 2.59 vs. 3.46 +/- 1.83 cm, P<0.001). The SUVT group exhibited significantly lower VAS pain scores on the postoperative 3(rd), 7(th) and 30(th )day (all P<0.001). A higher proportion of masses in the superior mediastinum was observed in the SUVT group compared to the non-SUVT group (P<0.001). No significant differences were found regarding demographic characteristics, operation time, intraoperative blood loss, the time and volume of drainage duration, postoperative hospital stay, and VAS pain score on the first postoperative day. Conclusions: The SUVT using a double sternum retractor demonstrated greater effectiveness in the complete removal of anterior mediastinal masses, even with a larger size or superior location and achieved less postoperative pain.