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Our experience of unilateral thoracoscopic thymectomy in children allowed us to simplify the procedure of pectus excavatum correction

Aurore Bouty, Marie Dabilly, Frederic Lavrand, Pierre Vergnes, Eric Dobremez

CHU Bordeaux, Bordeaux, France

 

Abstract 

Background: After a report of our experience of thymectomy by unilateral thoracoscopy, we will present the applications to other retrosternal surgeries.
Patients and methods: Unicentric retrospective analysis, from July 2003 to March 2010, of the 5 thoracoscopic thymectomies for Juvenile Myasthenia Gravis:
-  4 left-side surgical approaches, 1 right one (right extend of the thymus on the CT-scan)
-  4 flat supine positions, 1 full left lateral decubitus
Mean age at surgery was 10 years (7.5-13.5).
Results: Mean operative time was 117 minutes (75-195). Insufflation of Carbon dioxide was done in 4 cases; selective one-lung ventilation was used in one. We used a three-port technique, except for the right thoracoscopy (4 ports). We placed 1 (3 children) to 2 (1 child) chest tubes for 2 to 4 postoperative days. Only one child had no drainage. We opened the other pleura in only one case. No conversion to sternotomy was ever necessary. Histologic study showed thymic hyperplasia for each specimen. The only postoperative complication was a chylothorax after the right thoracoscopy, requiring a prolonged drainage for a week.
Conclusion: Compared to sternotomy (literature data), unilateral thoracoscopy:
-  Has an average operative time a third shorter
-  Hasn’t shown any complication
-  Brings a real aesthetic benefit
This cohort shows that, compared to sternotomy, historically used for thymectomy, unilateral thoracoscopy in supine position presents a benefit. In this extra pulmonary surgery, opening both pleura is not associated with specific complications. Our experience allowed us, from 2006, to perform implantation of a Nuss bar under video assisted control, for the correction of pectus excavatum, in the same surgical conditions.