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Single-Port Thymectomy Using a Subxiphoid Approach

Tuesday, June 16, 2015

In a previous study, the author reported the application of single-port thymectomy through an infrasternal approach. In this video, the surgical technique is shown. The patient was placed in the supine position with his legs spread, and the surgeon stood between the patient’s legs. First, a 3 cm transverse incision was made below the xiphoid process. A port was then inserted into the wound below the xiphoid process, and CO2 was insufflated at a pressure of 8 mmHg. The surgeon held grasper forceps designed for single-incision surgery in the left hand, and a vessel sealing device in the right hand. The mediastinal pleura was incised to enter the pleural cavities. The thymectomy was performed. Since this single-port subxiphoid approach can be performed through a single 3 cm incision in the abdominal region, it is aesthetically excellent. It is among the least invasive of thymectomy procedures, because no sternal incision is applied and the intercostal nerves are not injured.


Dear Prof T Suda, my compliments for your excellent technique. I would to ask you if you are currently using the 2-mm Kirschner wire to lift the sternum that you describe in the article published on the Annals of Thoracic Surgery (January 2012Volume 93, Issue 1, Pages 334–336). Thank you very much in advanced G Aresu
Dear Dr. Aresu, Thank you for your comments. We have used the Kirschner wire technique only for the initial cases, but we have noted that surgery can performed without the technique. Insufflated CO2 displaced the lungs and pericardium, opening up the space behind the sternum, which allowed us to resume single-port surgery via the subxiphoid. I do not use the technique anymore. I did not use the technique in this video. Takashi Suda, MD

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