Left VATS Thymectomy in a Patient With a Left SVC Using Wristed VATS Instruments

This is a video of a patient with a thymoma and myasthenia gravis who also has a left SVC.

If there was one person who you would like to have a left SVC, it would be a person with a thymoma. That is sometimes the most difficult part of the operation: taking the thymus off the innominate and finding the thymic vein and dividing it. But this leaves the question: where is the thymus now going to drain into and will there be other anatomical variants in the operation?

The author also chose to use the ArtiSential® wristed instruments, which are a fantastic way of getting the best of the versatility of robotics but for a fraction of the cost. In addition, the surgeon can stand by the patient and adjust ports or change the camera to other ports more easily as the author did here, using a subxiphoid port to see the opposite phrenic.

The SVC can be viewed in the video at 13:30, and at the end, the arch of the aorta with the innominate artery, left carotid, left subclavian artery, and the trachea.

Disclosure

Joel Dunning received £12,000 in total honoraria towards the development of the ArtiSential® wristed instruments by Livsmed in the past. In addition, they receive free samples of the instruments for testing and use within an ethics-approved single center clinical trial registered with their hospital’s research department.