The “Heat-and-Cold” Strategy: Combining Intercostal Nerve Cryoablation for Analgesia After Uniportal VATS Pleurectomy and Hyperthermic Intrathoracic Chemotherapy

We report interesting images from a 54-year-old woman with recurrent B2 thymoma associated with myasthenia gravis, treated using a minimally invasive uniportal VATS pleurectomy combined with hyperthermic intrathoracic chemotherapy (HITHOC). Preoperative imaging identified two hypermetabolic pleural lesions. Complete resection was achieved, followed by cisplatin-based HITHOC. Postoperative pain was managed by a multimodal approach combining erector spinae plane block and intercostal nerve cryoablation, resulting in a VAS score of two on the first postoperative day, decreasing to zero subsequently, and with no opioid requirement to control pain. The patient experienced an uneventful recovery and rapid discharge. This case highlights the feasibility and safety, with favourable outcomes in this patient. Larger and comparative series are needed to confirm the potential advantages of combining minimally invasive surgery with advanced analgesic strategies in complex thoracic oncology.