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. 2017 Nov 17:3:171.
doi: 10.21037/jovs.2017.09.13. eCollection 2017.

Subxiphoid uniportal VATS thymectomy

Marcin Zieliński  1 , Mariusz Rybak  1 , Katarzyna Solarczyk-Bombik  1 , Michal Wilkojc  1 , Wojciech Czajkowski  1 , Sylweriusz Kosinski  2 , Edward Fryzlewicz  2 , Tomasz Nabialek  2 , Malgorzata Szolkowska  3 , Juliusz Pankowski  4
Affiliations

Subxiphoid uniportal VATS thymectomy

Marcin Zieliński et al. J Vis Surg. .

Abstract

Background: To present the technique of minimally invasive extended thymectomy performed through the uniportal subxiphoid approach, with double elevation of the sternum for nonthymomatous myasthenia gravis (MG).

Methods: Operative technique: the whole dissection was performed through the 4-7 cm transverse or longitudinal subxiphoid incision with use of videothoracoscope. The sternum was elevated with two hooks connected to the sternal frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland). The lower hook was inserted through the subxiphoid incision and the superior hook was inserted percutaneously, after the mediastinal tissue including the major mediastinal vessels were dissected from the inner surface of the sternum. The fatty tissue of the anterior mediastinum and the aorta-pulmonary window was completely removed.

Results: There were four patients in the period 1.1.2017-30.4.2017. There was no mortality and morbidity.

Conclusions: The uniportal subxiphoid approach combined with double elevation of the sternum enabled very extensive thymectomy in case of thymoma.

Keywords: Subxiphoid; mediastinum; myasthenia gravis (MG); thymectomy; thymoma.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Subxiphoid incision, elevation of the sternum, opening of the right mediastinal pleura, dissection of the mediastinal tissue from the sternum, introduction of the percutaneous hook elevating the sternal manubrium (20). Available online: http://www.asvide.com/articles/1822
Figure 2
Figure 2
Dissection of the thymus and the surrounding mediastinal tissue from the neck, the mediastinal vessels and the pericardium (21). Available online: http://www.asvide.com/articles/1823
Figure 3
Figure 3
Completion of dissection and extraction of the specimen from the chest, the view of the specimen and chest wall after closure of the incision (22). Available online: http://www.asvide.com/articles/1824
See this image and copyright information in PMC

References

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