A case of giant thymolipoma: case report.

Background: Thymolipoma is a rare benign anterior mediastinal tumor. Traditionally, resection of giant thymolipoma (often ≥15 cm) required open surgery. This report describes a case of successful resection of a 19-cm thymolipoma using dual-port video-assisted thoracoscopic surgery (VATS). Case Description: A 67-year-old male patient presented with progressive cough and dyspnea. Computed tomography (CT) revealed a 19 cm × 13 cm × 4 cm fat-density mass in the anterior mediastinum, consistent with the typical features of a thymolipoma. Given the high diagnostic certainty on imaging, the patient underwent surgery without preoperative biopsy. A two-port left-sided VATS procedure was performed using a 1.5-cm observation port and a 5-cm working port. The tumor was dissected using ultrasonic scalpel while identifying and preserving the phrenic nerves. The vascular pedicle was ligated and transected near the ascending aorta. Complete tumor enucleation was achieved through an extended anterior port incision. Pathology confirmed a thymolipoma. The patient recovered uneventfully with immediate symptom resolution. Conclusions: This case demonstrates that dual-port thoracoscopic surgery is a feasible and safe strategy for complete resection of giant thymolipoma. Key elements include: precise preoperative imaging diagnosis, advanced dual-port VATS technique with reliable vascular control, and appropriate specimen extraction. This approach minimizes surgical trauma and represents an advancement in minimally invasive treatment for large benign mediastinal tumors.