Dual-port thymectomy using subxiphoid approach

Suda, Takashi; Ashikari, Shuhei; Tochii, Daisuke; Tochii, Sachiko; Takagi, Yasushi

doi:10.1007/s11748-013-0337-y

Cited by 23 publications

(16 citation statements)

References 4 publications

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“…Although the bilateral approach provided adequate exposure of the anterior mediastinum, a higher number of incisions was needed, which may increase operative trauma and postoperative pain (11,17,26,28). Hsu (24,25), Zielinski (18,29,30) and Suda (19,20) reported thoracoscopic thymectomy partially or only via subxiphoid incisions. Hsu CP created a 6-cm semi-curved subxiphoid incision and used the Kent retractor to lift the sternum.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the instruments may interfere with each other. Therefore, they further developed a dual-port thymectomy (19). Although all these approaches provided acceptable view of both sides, there were a few relative shortcomings.…”

Section: Discussionmentioning

confidence: 99%

“…It is an acceptable alternative to conventional thoracoscopic extended thymectomy. fat and ectopic thymic tissue without additional incision (15,16,19,20,22).By carefully analyzing the anatomy of anterior mediastinum, we have developed a new approach via subxiphoid and subcostal arch. The whole anterior mediastinal space was adequately visualized.…”

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confidence: 99%

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Subxiphoid and subcostal arch “Three ports” thoracoscopic extended thymectomy for myasthenia gravis

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Subxiphoid and subcostal arch “Three ports” thoracoscopic extended thymectomy for myasthenia gravis

et al. 2018

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“…Representative examples are the lateral intercostal approach in video-assisted thoracoscopic surgery thymectomy (VATS thymectomy) and robot-assisted thymectomy, cervical incision in transcervical thymectomy and the infrasternal approach [1][2][3][4][5]. Of these, VATS thymectomy is currently the most frequently performed surgical procedure, but it has some drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results

Suda

Hachimaru

Tochii

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Compared with conventional median sternotomy, approaches used in thymectomy for myasthenia gravis and anterior mediastinal tumours have become much less invasive in recent years. We previously developed a surgical technique called single-port thymectomy (SPT) to excise the thymus through a single opening made below the xiphoid process. In this study, to show the utility of SPT, we compared factors contributing to low surgical invasiveness between SPT and conventional video-assisted thoracoscopic surgery (VATS) thymectomy. METHODS:Between January 2005 and December 2014, 146 patients underwent surgery for anterior mediastinal tumour or myasthenia gravis at our hospital. After excluding patients diagnosed with tumour invasion of nearby organs or those who had undergone concurrent removal of nearby organs, 81 patients were enrolled in this retrospective study as subjects. Patients were divided into the VATS thymectomy group (VATS group, n = 35) and the SPT group (n = 46). Surgical duration, blood loss, duration of hospital stay and the amount and duration of postoperative oral analgesics were compared between the groups. RESULTS:Operating time did not vary significantly between the VATS and SPT groups (P = 0.0853). The amount of blood loss was higher in the VATS group than in the SPT group (P < 0.0001). The duration of hospital stay was longer in the VATS group than in the SPT group (P = 0.0008). The amount of postoperative oral analgesics was significantly higher in the VATS group than in the SPT group (P = 0.0092). Similarly, the duration of postoperative oral analgesics was significantly longer in the VATS group than in the SPT group (P = 0.0312). CONCLUSIONS:Compared with VATS thymectomy, SPT required a similar operating time, was associated with less blood loss and enabled postoperative analgesics to be discontinued earlier. Therefore, it could be considered a less invasive surgical approach.

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“…good aesthetic outcomes [4]. For surgeons, however, the surgical procedure is technically demanding [5]. We developed this new technique by combining the subxiphoid approach performed through a midline camera port with the use of the da Vinci multijoint robotic system to ensure a clear operative view and improved manoeuvrability as a minimally invasive surgical procedure for patients untreatable with SPT.…”

Section: Videomentioning

confidence: 99%

Trans-subxiphoid robotic thymectomy

Suda

Tochii

et al. 2015

Interact CardioVasc Thorac Surg

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Minimally invasive surgery has replaced median sternotomy for resectable anterior mediastinal masses and is performed by various approaches. We developed a new minimally invasive surgical procedure by combining the subxiphoid approach performed through a midline camera port with the use of a robotic surgery system (Intuitive Surgical, Sunnyvale, CA, USA). A 3-cm transverse incision was made 1 cm below the xiphoid process. Then, a port designed for single-port surgery was inserted. Through this port, CO2 gas was injected at 8 mmHg. The thymus was then detached from the back of the sternum. A 1-cm skin incision was made bilaterally in the sixth intercostal space, followed by insertion of a port for the robotic system. A camera port was inserted into the subxiphoid port, to which the camera scope was mounted, and thymectomy was performed. We have performed the operation in 3 patients. In our experience, this procedure provides a good operative view in the neck region and makes verification of the phrenic nerve easy. Furthermore, with the da Vinci surgical system, which enables surgical manipulation from a correct angle due to the multijoint robotic arms, trans-subxiphoid robotic thymectomy may be a promising new thymectomy procedure.

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Dual-port thymectomy using subxiphoid approach

Cited by 23 publications

References 4 publications

Subxiphoid and subcostal arch “Three ports” thoracoscopic extended thymectomy for myasthenia gravis

Subxiphoid and subcostal arch “Three ports” thoracoscopic extended thymectomy for myasthenia gravis

Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results

Trans-subxiphoid robotic thymectomy

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