Case Report: Feasibility of Video-Assisted Thoracoscopic Thymectomy in Giant Thymoma

Tatiana K. Jenkins; Cortnie R.  Vaughn; Daniel Labuz; Ruchi  Thanawala; Kenneth Azarow

doi:10.70422/e1qzht09

Authors

Tatiana K. Jenkins, MD Oregon Health and Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR USA Author https://orcid.org/0009-0000-3134-9393
Cortnie R. Vaughn, MD Oregon Health and Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR USA Author https://orcid.org/0009-0001-0070-8979
Daniel Labuz, MD Oregon Health and Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR USA Author https://orcid.org/0000-0002-9078-3162
Ruchi Thanawala, MD Oregon Health and Science University, Department of Surgery, Division of Thoracic Surgery, Portland, OR, USA Author https://orcid.org/0000-0002-1419-4737
Kenneth Azarow, MD Oregon Health and Science University, Department of Surgery, Division of Pediatric Surgery, Portland, OR USA Author https://orcid.org/0009-0007-6559-5219

DOI:

https://doi.org/10.70422/e1qzht09

Keywords:

Thymoma, Thymectomy, Giant Thymoma, Pediatric Surgery, VATS, Video-Assisted Thoracoscopic Surgery, Video-Assisted Thoracoscopic Thymectomy

Abstract

Background: Thymomas are slow-growing mediastinal masses, usually resectable through minimally invasive approaches. However, some thymomas, referred to as 'giant thymomas', can exceed 10 cm and are thought to require open resection. There are few reports of successful removal via video assisted thoracoscopic surgery (VATS) in adults. We present the first case of a giant thymoma resected via VATS in the pediatric population.

Case Presentation: A 17-year-old female presented with a bilobed, anterior mediastinal mass. Three family members had history of thymoma resected via median sternotomy. Adult thoracic surgery and pediatric surgery collaborated on a bilateral VATS approach with left mini thoracotomy for mass extraction. On gross pathology, the specimen measured 16 cm in maximum dimension and the margins were negative. Epidural analgesia was utilized with minimal postoperative opioid needs. The patient was discharged to home on post-operative day 3.

Conclusion: Bilateral VATS with mini-thoracotomy for extraction is a feasible approach for the resection of a pediatric, giant thymoma. Comprehensive pain management, including a thoracic epidural, allowed for excellent pain control and facilitated rapid discharge. Collaboration between adult thoracic surgery and pediatric general surgery was fundamental to the success of this approach.

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Case Report: Feasibility of Video-Assisted Thoracoscopic Thymectomy in Giant Thymoma

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