Abstract: Objective To summarize the key surgical points of subxiphoid thoracoscopic thymectomy and compare its clinical efficacy with lateral thoracic approach thymectomy.Methods Clinical data of 93 patients who underwent thoracoscopic thymectomy for thymic tumors at Wuhan Tongji Hospital from February 2021 to March 2023 were collected.The patients were divided into the subxiphoid group (n=40) and the lateral thoracic group (n=53) according to the surgical approach.Surgical outcomes,perioperative indicators,and postoperative pain were compared between the two groups.Results Both groups of patients underwent complete or extended thymectomy via thoracoscopy without conversion to open surgery.The subxiphoid group had significantly shorter operation time for complete thymectomy [(60.32±1.53)minutes],operation time for extended thymectomy [(114.52±11.63)minutes],duration of chest tube placement [(3.20±0.91)days],and length of hospital stay [(4.00±0.16)days] compared to the lateral thoracic group [(66.62±1.45)minutes,(138.76±6.35) minutes,(4.00±1.22)days and (4.70±0.18)days,respectively],with statistical significance (P＜0.05).The subxiphoid group also had lower VAS scores at 24 hours (3.8±0.8),48 hours (3.0±0.7),and 72 hours (2.6±0.9) postoperatively,compared to the lateral thoracic group [(5.7±0.9),(4.7±0.8),(3.2±0.8),respectively],with statistical significance (P＜0.05).There were no significant differences between the two groups in terms of intraoperative blood loss,hospital costs,complication rates,and abnormal sensations after 30 days postoperatively (P＞0.05).Conclusion Modified modular subxiphoid thoracoscopic thymectomy is safe and reliable,and offers significant perioperative advantages,especially for patients with Masaoka stage I and II thymomas accompanied by myasthenia gravis (MG).

Key words: thymic tumor; subxiphoid approach; thoracoscopy; surgical key points