Right VATS thymectomy, utilising a subxiphoid incision and the LigaSure retractable L-hook

We describe a technique of right sided video-assisted thoracoscopic surgery (VATS) thymectomy in a lady who had a large 7 cm mass which was adherent to the pericardium, extended into the superior poles of the thymus and had adhesions to the lung bilaterally. We utilized 3 mm × 5 mm ports from the right-hand side and a 12 mm subxiphoid incision which was used to retrieve the tumour at the end of the case. Due to the bulky nature of the tumour we also added a 5 mm port to the left chest to visualize the left phrenic nerve towards the end of the case. The pericardium is widely excised in this case as the tumour is adherent to it. The LigaSure L-hook is demonstrated which was particularly useful in this case. This device can grasp, blunt dissect, cut and seal as usual like any other LigaSure, but there is a switch that can retract the LigaSure back and advance a hook diathermy without removing the instrument from the chest. We hope this video and description demonstrates that endoscopic thymectomy is safe and feasible even in more difficult cases and provides the same completeness of resection as open surgery.