Uniportal subxiphoid thoracoscopic thymectomy with the Tian-Ping sternal lifter: a prospective non-randomized comparative study

Background: Conventional minimally invasive thymectomy (MIT) can be limited by insufficient retrosternal exposure, while existing sternal elevation techniques still have technical limitations. This study aimed to introduce a novel percutaneous suspension-assisted subxiphoid thoracoscopic thymectomy with Tian-Ping sternal lifter and compare its perioperative outcomes to conventional MIT.

Methods: The single-center prospective observational study with a non-randomized comparative design was conducted between June 2024 and June 2025. Consecutive adult patients with resectable anterior mediastinal masses scheduled for MIT were enrolled. Group A underwent uniportal subxiphoid thymectomy using the Tian-Ping sternal lifter, and Group B underwent conventional MIT. Treatment allocation was based on patient preference and surgeon judgment. The primary outcome was postoperative pain, assessed using visual analog scale (VAS) scores on postoperative days 1, 3, 7, and 30. Secondary outcomes comprised perioperative indicators of surgical safety and feasibility, including 30-day postoperative complications. Propensity score matching was used to improve baseline comparability between the groups, after which the primary and secondary outcomes were compared between the matched groups.

Results: A total of 139 patients [mean (standard deviation, SD) age, 49.5 (12.0) years; 71 females (51.1%)] were included after one preoperative exclusion, with 50 in the Group A and 89 in the Group B. After propensity score matching, 49 patients remained in each group, with comparable baseline characteristics. In the matched cohort, Group A had lower VAS scores than Group B on postoperative day (POD) 1 [median (interquartile range, IQR), 1.00 (0.00–1.00) vs. 1.00 (1.00–2.00); P<0.01], POD 3 [0.00 (0.00–1.00) vs. 1.00 (0.00–1.00); P=0.01], and POD 7 [0.00 (0.00–0.00) vs. 0.00 (0.00–1.00); P<0.01]. Operation time showed a nonsignificant trend toward reduction in Group A [82.0 (70.0–109.0) vs. 96.0 (75.0–140.0) minutes; P=0.07], whereas intraoperative blood loss remained lower [10.0 (5.0–10.0) vs. 10.0 (10.0–20.0) mL; P=0.01]. Chest tube placement was less frequent in Group A (32.7% vs. 100.0%; P<0.01), and postoperative length of stay was shorter [3.0 (2.0–4.0) vs. 3.0 (3.0–4.0) days; P=0.02]. No significant differences were observed in R0 resection (100.0% vs. 95.9%; P=0.49) or 30-day postoperative complications (2.0% vs. 6.1%; P=0.62).

Conclusion: Tian-Ping sternal lifter-assisted uniportal subxiphoid thymectomy was feasible and associated with lower early postoperative pain scores and favorable short-term outcomes.