Video Demonstration of a Left VATS Thymectomy With Instruments Mimicking the Human Hand
In this video, we are demonstrating a left VATS thymectomy with complete dissection of the superior horns using the new wristed Artisential instruments by livsmed. Our patient is a 62 year old woman, approach is semi-supine with left arm attatched; we used three ports and a 30° camera and CO2 insufflation. We used three Artisential instruments, the fenestrated forceps, the bipolar precise dissector and the monopolar hook, together with a Caiman energy device from Aesculap.
This female patient has a little thymoma, roughly one inch in diameter, as you can see here in the CT-scan. This is the thymoma, clearly visible within the thymic fat. The pleura along the pericardium and the anterior chest wall is divided with the bipolar dissector. The plane between the pericardium and the thymus is developed with the energy device and by blunt dissection. Sharp dissection is performed with the scissors around the area of the phrenic nerve. The pleura along the sternum is divided with the bipolar dissector. Lateral attatchments are divided….and small vessels coming in from the mammary vessels are dissected with the energy device. The fascial attatchments to the sternum and posterior clavicula head are divided with the hook…likewise the attatchments between the thymus and the pericardium.
The plane between the left superior horn and the innominate vein is developed by blunt dissection and bipolar which is very much facilitated by the use of the wristed Artisential bipolar precise dissector while continuously tensing the tissue with the fully articulating fenestrated forceps. Bigger portions are divided with the energy device. After preparation of the small thymic veins, the plane between the right superior horn and the innominate vein is developed with the bipolar dissector. The cervical dissection of the superior horns continues up to the jugular vein and the inferior thyroid veins. The small thymic veins are being divided using clips.
The dissection continues to the right side and right pleura, which can be seen being ventilated in the background. The mediastinal fat to the right side is dissected up to the level of the right mammary vein. Remaining attachments to the pericardium are divided with the monopolar hook and the energy device. The thymus gland is then placed in a bag and brought out through one of the port sites. Finally, we checked for minor sources of bleeding and performed punctual hemostasis with the precise bipolar dissector. This is the resected gland….thank you for watching!
