Patient Positioning and Preparation: Right-Side Thymectomy

Set up patient supine on OR table with flank positioned at the break in the table.
Align right chest with edge of OR table, allowing patient’s arm to drop down alongside operating table rail.
Single-lung ventilation is placed using a double-lumen ET tube or endobronchial blocker.
Place a roll or 8” gel roll under the ipsilateral mid-thorax (caudal of scapula) side from the approach point of the patient side cart. This lifts the thorax, drops the shoulder, and spreads the intercostal spaces.
Pad pressure points and bony prominences. Appropriately secure the body position to the OR table. Sterilely drape the patient. The lateral chest and axilla are exposed down to the OR table top for port placement.
Perform examination under anesthesia to facilitate port placement. Identify and mark anatomic landmarks: Suprasternal notch, xiphoid process, angle of Louis, and intercostal spaces.

Port Placement — Right-Side Thymectomy

Camera Port, 8.5 mm (Blue): The camera port is placed first. Discern the midpoint of the sternum, between the manubrium and xiphoid process. Place the camera port approximately 1 to 2 ribs below the midpoint of the sternum along the lateral margin of the breast. This is approximately nipple level (4th) or just below. Be careful to avoid placing the port into the breast itself, which is slightly medial to the anterior axillary line.
Superior Port 8 mm (Green): This port is placed 8 cm superior to the camera port and slightly medial to the anterior axillary line. Be careful not to get into the axilla or shoulder. As with all port placement, use the camera to visualize a needle passed thru the anticipated port location to confirm optimal placement. Be aware of the arm and shoulder relationship to the incoming robotic arm. It should also be placed inferior to the right shoulder to avoid collisions with the patient.
Inferior Port 8.5 mm (Yellow): This port is placed third. Using external landmarks, instrument arm is placed 8 cm inferior to the camera port and slightly medial to the anterior axillary line.
Assistant Port (A), 8 mm (Black): Place the assistant Port Placement, Right-Side Procedure port midway between the camera port and robotic arm and a minimum of 5 cm posterior and lateral to the camera port, forming an isosceles triangle between the camera and the inferior port .