[Endoscopic surgery with the sternum-lifting method]

Fourteen years have passed since video-assisted thoracic thymectomy (VATS-T) began to be used to treat diseases of the thymus. Indications for VATS-T have been expanded by ensuring sufficient space for easy endoscope manipulation using the sternum-lifting method. A variety of VATS-T techniques are available, including the cervical approach, bilateral VATS, infrasternal approach, and others. Although these techniques have the common feature of not involving sternotomy, they differ from each other in terms of the extent of thymectomy. In Japan, bilateral VATS (involving neck incision combined with sternum lifting) or the infrasternal approach (based on the full-directional technique) is often used for extended or maximal thymectomy in myasthenia gravis patients. In a short-term prospective study, VATS-T was shown to be more beneficial than sternotomy in myasthenia gravis patients and those with noninvasive thymoma. With the overall trend toward increased performance of minimally invasive surgery, VATS-T has been more widely adopted as a surgical approach for patients with diseases of the thymus. However, as the number of patients treated with VATS-T has increased, problems specific to endoscopic surgery have become an increasing concern. Whether VATS-T can be considered truly beneficial for patients will depend on the success or failure in solving these problems and the results of long-term prospective studies on the prognosis of patients after treatment with this procedure.