{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:19:30Z","timestamp":1764785970192,"version":"3.46.0"},"reference-count":10,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,19]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Thymectomy is performed for the treatment of myasthenia gravis (MG) and the removal of thymic lesions. Minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have now become a standard of care for thymectomies. We present the case of a woman in her early 50s with non-thymomatous MG and left atrial isomerism. As part of left atrial isomerism, she had bronchial isomerism with no right middle lobe, hemiazygous vein continuation of the inferior vena cava, bilateral superior vena cavae and no left brachiocephalic vein. A bilateral VATS approach provided a safe and effective technique for the removal of the thymus and the patient was discharged on postoperative day 2. While considerations must be taken from both the anaesthetist (altered bronchial anatomy) and operator (aberrant venae cavae and brachiocephalic veins), minimally invasive techniques can provide an effective alternative to open thymectomy in patients with anomalous anatomy.<\/jats:p>","DOI":"10.1136\/bcr-2025-269757","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:15:25Z","timestamp":1764785725000},"page":"e269757","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["VATS thymectomy in left atrial isomerism"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9151-6112","authenticated-orcid":false,"given":"Edward","family":"Staniforth","sequence":"first","affiliation":[{"name":"General Surgery, Mid Yorkshire Teaching NHS Trust, Wakefield, UK"},{"name":"Medical School, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anchal","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhona","family":"Taberham","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionisios","family":"Stavroulias","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"2025120310151424000_18.12.e269757.1","doi-asserted-by":"crossref","DOI":"10.21037\/med-21-25","article-title":"Open redo thymectomy for a large recurrent thymoma in a patient with myasthenia gravis: a case report","volume":"6","author":"Galata","year":"2022","journal-title":"Mediastinum"},{"key":"2025120310151424000_18.12.e269757.2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s11748-020-01495-z","article-title":"Subxiphoid dual-port thymectomy for thymoma in a patient with post-aortic left brachiocephalic vein","volume":"69","author":"Naito","year":"2021","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2025120310151424000_18.12.e269757.3","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s11748-011-0817-x","article-title":"First experience of robotic extended thymectomy in Japan for myasthenia gravis with thymoma","volume":"60","author":"Nakamura","year":"2012","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2025120310151424000_18.12.e269757.4","first-page":"10","article-title":"Thoracoscopic thymectomy using a left-side approach","volume":"2018","author":"Abdelnour-Berchtold","year":"2018","journal-title":"Multimed Man Cardiothorac Surg"},{"key":"2025120310151424000_18.12.e269757.5","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1093\/icvts\/ivx136","article-title":"Video-assisted thoracoscopic thymectomy for non-thymomatous myasthenia gravis: a right-sided or left-sided approach?","volume":"25","author":"Elsayed","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2025120310151424000_18.12.e269757.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.03.063"},{"key":"2025120310151424000_18.12.e269757.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1969.03160190028006"},{"key":"2025120310151424000_18.12.e269757.8","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jtcvs.2016.01.044","article-title":"Thymectomy using the subxiphoid approach","volume":"152","author":"Yano","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120310151424000_18.12.e269757.9","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/00125817-200005000-00002","article-title":"Heterotaxy: associated conditions and hospital-based prevalence in newborns","volume":"2","author":"Lin","year":"2000","journal-title":"Genet Med"},{"key":"2025120310151424000_18.12.e269757.10","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.5114\/aoms.2020.97972","article-title":"Polysplenia syndrome with a rare variation between the common hepatic artery and the superior mesenteric artery in adults","volume":"16","author":"Liu","year":"2020","journal-title":"Arch Med Sci"}],"container-title":["BMJ Case 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