Advertisement

Subxiphoid Mediastinal Resections

  • Takashi SudaEmail author
Chapter

Abstract

We previously developed a surgical technique called subxiphoid single-port thymectomy to excise the thymus through a single opening made below the xiphoid process. This procedure is facilitated by creating adequate space for surgery by inducing compression of bilateral lungs and the mediastinum by means of CO2 insufflation. We previously reported a comparative study of the early outcomes after VATS thymectomy and single-port thymectomy performed at our hospital from January 2005 to December 2014. Subxiphoid single-port thymectomy takes the same amount of operative time as VATS thymectomy via a lateral thoracic approach, but results in less blood loss and enables earlier termination of postoperative analgesics. This method offers an excellent cosmetic outcome with just one 3-cm incision in the abdomen and is the most minimally invasive form of thymectomy that avoids sternotomy and intercostal nerve injury. Investigation of the safety of this procedure and long-term therapeutic outcomes for myasthenia gravis and anterior mediastinal tumors is necessary.

Keywords

Thymectomy Subxiphoid Thoracoscopy/VATS 

Notes

Conflict of Interest

None declared.

Supplementary material

Video 1

(WMV 476469 kb)

References

  1. 1.
    Cooper JD, Al-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg. 1988;45(3):242–7.CrossRefGoogle Scholar
  2. 2.
    Landreneau RJ, Dowling RD, Castillo WM, et al. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg. 1992;54(1):142–4.CrossRefGoogle Scholar
  3. 3.
    Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg. 1993;56:653–6.CrossRefGoogle Scholar
  4. 4.
    Ashton RC Jr, et al. Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg. 2003;75:569.CrossRefGoogle Scholar
  5. 5.
    Ruckert JC, et al. J Thorac Cardiovasc Surg. 2011;141:673.CrossRefGoogle Scholar
  6. 6.
    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.CrossRefGoogle Scholar
  7. 7.
    Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg. 1999;67:263–5.CrossRefGoogle Scholar
  8. 8.
    Suda T, Sugimura H, Tochii D, Kihara M, Hattori Y. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg. 2012;93(1):334–6.CrossRefGoogle Scholar
  9. 9.
    Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg. 2014;62(9):570–2.CrossRefGoogle Scholar
  10. 10.
    Suda T, Tochii D, Tochii S, Takagi Y. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg. 2015;20(5):669–71.CrossRefGoogle Scholar
  11. 11.
    Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results. Eur J Cardiothorac Surg. 2016;49:i54–8.CrossRefGoogle Scholar
  12. 12.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Lobectomy—video-assisted thoracic surgery versus muscle-sparing thoracotomy: a randomized trial. J Thorac Cardiovasc Surg. 1995;109(5):997–1001.CrossRefGoogle Scholar
  13. 13.
    Furrer M, Rechsteiner R, Eigenmann V, Signer C, Althaus U, Ris HB. Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997;12(1):82–7.CrossRefGoogle Scholar
  14. 14.
    Suda T, Sugimura H, Hattori Y. Single port thymectomy – a step towards “scarless” thymectomy to replace robotics? (reply). Ann Thorac Surg. 2012;94(6):2176–7.CrossRefGoogle Scholar
  15. 15.
    Suda T, Ashikari S, Tochii S, Sugimura H, Hattori Y. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg. 2014;97(2):718–9.CrossRefGoogle Scholar
  16. 16.
    Liu CC, Wang BY, Shih CS, Liu YH. Subxiphoid single-incision thoracoscopic left upper lobectomy. J Thorac Cardiovasc Surg. 2014;148(6):3250.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of Thoracic SurgeryFujita Health University School of MedicineToyoakeJapan

Personalised recommendations