Minimally invasive subxiphoid-right, videothoracoscopic technique of thymectomy for thymoma and rethymectomy

Minimally invasive subxiphoid-right, videothoracoscopic (VATS) technique of thymectomy for thymoma is presented. This approach enables complete removal of the whole thymus, with visualization of the lower poles of the thyroid. The whole dissection is performed through the 4-7 cm subxiphoid approach with single 5-mm port insertion into the right chest cavity for the thoracoscope and, subsequently for the chest tube. The sternum is elevated with two hooks connected to the sternal frame. The lower hook is inserted through the subxiphoid incision and the superior hook is inserted percutaneously after the mediastinal tissue including the major mediastinal vessels that are dissected from the inner surface of the sternum. Generally, the left mediastinal pleura is not opened. The fatty tissue of the perithymic, right pericardiophrenic and aorta-pulmonary window can be completely removed. The dissection of the lower neck, aorta-caval groove and the left pericardiophrenic areas are not as complete as in the previously reported transcervical-subxiphoid, -bilateral VATS maximal thymectomy, however, therefore, the subxiphoid-right VATS technique of thymectomy have been used for early stage thymomas, not for non-thymomatous Myasthenia gravis. In this article, some important steps facilitating safe and straightforward performance of the procedure are presented and the methods of management of intraoperative complications are discussed.