Video Demonstration of a Left VATS Thymectomy With Instruments Mimicking the Human Hand

In this video, we demonstrate a left VATS thymectomy with complete dissection of the superior horns using the new wristed ArtiSential instruments by LivsMed. The patient was a 62-year-old woman. The approach was semi-supine with left arm attached; 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.

The patient had a small thymoma, roughly one inch in diameter, as you will see in the CT-scan. The thymoma was clearly visible within the thymic fat. The pleura along the pericardium and the anterior chest wall was divided with the bipolar dissector. The plane between the pericardium and the thymus was developed with the energy device and by blunt dissection. Sharp dissection was performed with the scissors around the area of the phrenic nerve. The pleura along the sternum was divided with the bipolar dissector. Lateral attachments were divided and small vessels coming in from the mammary vessels were dissected with the energy device. The fascial attachments to the sternum and posterior clavicula head were divided with the hook; likewise, the attachments between the thymus and the pericardium.

The plane between the left superior horn and the innominate vein was developed by blunt dissection and bipolar dissector, which was 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 were divided with the energy device. After preparation of the small thymic veins, the plane between the right superior horn and the innominate vein was developed with the bipolar dissector. The cervical dissection of the superior horns continued up to the jugular vein and the inferior thyroid veins.  The small thymic veins were divided using clips.

The dissection continued to the right side and right pleura, which can be seen being ventilated in the background. The mediastinal fat to the right side was dissected up to the level of the right mammary vein.  Remaining attachments to the pericardium were divided with the monopolar hook and the energy device. The thymus gland was 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. Thank you for watching!

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