To explore the feasibility of non-intubated uniportal video-assisted thoracic surgery (NI UVATS) for the resection of mediastinal tumors via a subxiphoid approach, and to summarize the surgical techniques and clinical outcomes.

A retrospective analysis was conducted on the medical records of 20 patients who underwent NI UVATS for subxiphoid resection of mediastinal tumors by the same surgical team in the Department of Thoracic Surgery at Shanghai Pulmonary Hospital between Mar. 2019 and Jul. 2023. The pathological diagnoses included 11 cases of thymic cyst, 7 cases of thymoma, 1 case of thymic carcinoma, and 1 case of lymphoid hyperplasia.

All 20 procedures were successfully completed with radical resection, and no cases required conversion to open thoracotomy. The mean operative time was 66.00 ± 26.83 minutes. The mean drainage volume on the day of surgery was 265 (115, 435) ml, and the mean postoperative hospital stay was 2.85 ± 1.27 days. Among the 7 patients diagnosed with thymoma, one received postoperative radiotherapy and showed no metastasis or recurrence at the 3-year follow-up. The one patient diagnosed with thymic carcinoma received postoperative chemotherapy and radiotherapy, with no metastasis or recurrence observed at the 3-year follow-up. The mean postoperative follow-up duration was 28.5 ± 10.7 months, with a mortality rate of 0% during this period.

For carefully selected patients, NI UVATS for subxiphoid resection of mediastinal tumors is feasible when performed by an experienced uniportal VATS surgeon in close collaboration with an anesthesiologist.