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Conventional robotic-assisted subxiphoid thymectomy provides excellent visualization to both the phrenic nerve and the superior horn of the thymus gland, allowing the surgeon to effectively perform a radical thymectomy. However, this technique requires a 3 cm incision for subxiphoid dissection, and VATS dissection has some risk of injury to branches of the musculophrenic artery, the rectus abdominis, and the peritoneum, and special port is required.
In contrast, the double docking technique can eliminate all the downsides of the conventional technique. By entering the lateral pleural cavity with only two docking ports, including a camera, the surgeon can dissect the subxiphoid area and place an 8 mm port, followed by redocking the camera into the subxiphoid port. This approach allows the thymectomy to be performed in the same effective manner with less instruments and reduced surgical risk.
References
- Shimomura M, Ishihara S, Okada S, Inoue M. Robotic subxiphoid-optical thymectomy. Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2):ivac104. doi: 10.1093/icvts/ivac104. PMID: 35416955; PMCID: PMC9373970.
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4 Comments
How did you position patient?
Thank you for your question. Start with semi right lateral decubitus on first docking then rotate the bed upon second docking.
Excellent idea and technique. More than just the cosmetic advantage is the loss of the very frustrating and messy subxiphoid entry and excision of the xiphoid process. I would probably still do a vertical 8mm incision that can me enlarged for extraction unless the gland was very small.
Thank you for your kind comment. For extraction of specimen, I found that making submamillary incision from most lateral port working best cosmetically unless mass is too large for intercostal extraction.