Tubeless uniportal subxiphoid thoracoscopic thymectomy via percutaneous suspension technique for anterior mediastinal masses.

Objective: We previously developed the percutaneous suspension technique to improve the anterior mediastinal exposure in minimally invasive thymectomy. In this study, we aimed to integrate this technique with tubeless video-assisted thoracoscopic surgery (VATS) for uniportal subxiphoid thoracoscopic thymectomy and to evaluate perioperative outcomes of this combined approach. Methods: This retrospective, multicenter study included patients with anterior mediastinal masses who underwent uniportal subxiphoid thoracoscopic thymectomy using the percutaneous suspension technique combined with tubeless VATS at 4 centers between March and September 2025. Comprehensive early outcome data, including intraoperative and postoperative variables, were collected and analyzed. Results: In total, 15 patients were included, with a median age of 53 years (range, 25-75 years). Median operative and anesthesia times were 83 minutes (range, 35-192 minutes) and 140 minutes (range, 108-264 minutes), respectively. The median pain score was 2 (range, 1-3) on postoperative day 1 and was 0 in all patients on postoperative day 7. The median postoperative length of stay was 2 days (range, 1-4 days). No conversions and no major intraoperative or postoperative complications occurred. 5 patients (33.3%) developed mild pneumothorax and 3 (20.0%) developed mild atelectasis, all managed conservatively without chest drain insertion. No patient required reinsertion of a chest drain or urinary catheter during hospitalization or after discharge. Conclusions: Tubeless uniportal subxiphoid thoracoscopic thymectomy with the percutaneous suspension technique is safe and feasible for anterior mediastinal masses, although tubeless VATS potentially associated with a slightly higher incidence of minor complications.