Video-assisted thoracoscopic thymectomy.

Access from the right chest is generally easier. In this case however, the thymoma was predominantly left-sided and therefore a left-sided approach was preferred. The anesthetist places a double lumen tube to allow isolation of the required lung. The patient is placed with the chest elevated to an angle of around 30 degrees. This allows the plane between the sternum and thymus to be developed easily, while minimizing instrument clashes. The arm lies secured beside the chest (2). The chest wall is prepared from the posterior axillary fold to beyond the sternum, and from the jugular notch to just below the xiphisternum. This leaves the entire sternum exposed, making quick conversion to sternotomy possible if needed.