@article{Mediastinum4272,
author = {Takashi Suda},
title = {Subxiphoid single-port thymectomy procedure: tips and pitfalls},
journal = {Mediastinum},
volume = {2},
number = {3},
year = {2018},
keywords = {},
abstract = {We previously described a subxiphoid single-port thymectomy procedure with CO2 insufflation of the mediastinum and removal of the thymus via a single incision below the xiphoid process. This report describes an endoscopic subxiphoid, single-port thymectomy procedure, with tips to ensure success and pitfalls to avoid. The patient is placed in the supine position with the legs apart. A vertical or horizontal incision of approximately 3 cm is made 1 cm caudal to the xiphoid process. A finger is inserted behind the sternum via the subxiphoid wound to blindly detach the caudal side of the thymus from the sternum. A port for single-port surgery is inserted. CO2 insufflation is performed at 8 mmHg. The trick to safe use of the vessel sealing device is to perform separation by opening and closing the jaw tips before dissection, passing one of the jaws through the separated area, and then dissecting. In a subxiphoid single-port thymectomy, the thymic vein is sectioned last because it runs tangential to the subxiphoid wound and shifts laterally on the traction of the thymus. The thymus is removed from the body through the subxiphoid incision. The subxiphoid approach affords a cervical field of view that is superior to other approaches and makes it easy to identify the bilateral phrenic nerves. Furthermore, it is a minimally invasive approach that reduces the extent of intercostal nerve damage compared with the lateral intercostal approach. Thymectomy using the subxiphoid approach is a surgical technique that should be learned by respiratory surgeons.},
issn = {2522-6711}, url = {https://med.amegroups.org/article/view/4272}
}