To compare the safety and advantages of uniportal thoracoscopic thymectomy by different approaches.

One hundred and ninety-two patients with thymoma who underwent uniportal thoracoscopic thymectomy from January 2018 to September 2022 in Department of Cardiothoracic Surgery of Sanya Central Hospital (The Third People’s Hospital of Hainan) were retrospectively collected. An lateral group (LASP) with 65 cases and a subxiphoid group (SASP) with 127 cases were assigned, and finally 53 cases were matched in each group by propensity score matching. The indicators, including operative time, intraoperative blood loss, number of conversions to open surgery, postoperative drainage volume, chest tube indwelling time, and postoperative wound pain VAS scores at different time points, were compared and analyzed in the SASP and LASP groups.

A total of 106 patients were successfully matched. There was no significant difference in baseline data after matching (P>0.05). The operation time for the LASP group was shorter than that for the SASP group [ (103.453±25.992) min vs (114.509±25.142) min, P<0.05]. There was no statistical significance between the two groups in terms of intraoperative blood loss [60 (45~90) mL vs 55 (45~65) mL] and VAS score [5 (5~6) vs 5 (4~5) ] on the first day after surgery. The VAS score after extubation [4 (3~5) vs 4 (3~4) ], one week after the operation [2 (1~3) vs 1 (0~2) ], and the need for analgesic drugs in the first week after surgery were better in the SASP group than in the LASP group (P<0.05). There was no significant difference between the two groups in the data of postoperative drainage volume, drainage time, and the need for analgesic drugs after extubation (P>0.05) .

Both the lateral thorax and the subxiphoid approach are safe and effective. The subxiphoid approach has a longer operation time, but it has the advantage of less postoperative pain.