Display options
Share it on

J Vis Surg. 2017 Nov 17;3:171. doi: 10.21037/jovs.2017.09.13. eCollection 2017.

Subxiphoid uniportal VATS thymectomy.

Journal of visualized surgery

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

Affiliations

  1. Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland.
  2. Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland.
  3. Department of Pathology of the Tuberculosis Institute, Warsaw, Poland.
  4. Department of Pathology, Pulmonary Hospital, Zakopane, Poland.

PMID: 29302447 PMCID: PMC5730523 DOI: 10.21037/jovs.2017.09.13

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

Conflict of interest statement

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

References

  1. Eur J Cardiothorac Surg. 2013 Aug;44(2):e113-9; discussion e119 - PubMed
  2. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1739-42 - PubMed
  3. Surg Endosc. 2006 Oct;20(10):1614-8 - PubMed
  4. Ann Thorac Surg. 1999 Jan;67(1):263-5 - PubMed
  5. Eur J Cardiothorac Surg. 2003 Nov;24(5):677-83 - PubMed
  6. Eur J Cardiothorac Surg. 2010 Apr;37(4):824-6 - PubMed
  7. Arch Surg. 1987 Nov;122(11):1352-6 - PubMed
  8. J Thorac Cardiovasc Surg. 2011 Mar;141(3):673-7 - PubMed
  9. J Thorac Dis. 2015 Sep;7(9):1658-60 - PubMed
  10. Ann N Y Acad Sci. 1981;377:755-65 - PubMed
  11. Int Surg. 1994 Oct-Dec;79(4):378-81 - PubMed
  12. J Thorac Dis. 2016 Mar;8(Suppl 3):S265-71 - PubMed
  13. J Vis Surg. 2017 Jan 05;3:2 - PubMed
  14. Chest. 2000 Apr;117(4):1179-83 - PubMed
  15. Ann Thorac Surg. 2000 Jul;70(1):327-34 - PubMed
  16. Eur J Cardiothorac Surg. 2010 May;37(5):1137-43 - PubMed
  17. J Thorac Dis. 2016 Dec;8(12 ):E1602-E1604 - PubMed
  18. Ann Thorac Surg. 1977 Aug;24(2):120-30 - PubMed
  19. Przegl Lek. 2000;57 Suppl 5:64-5 - PubMed

Publication Types