World Journal of Surgery

, Volume 41, Issue 3, pp 763–770 | Cite as

The Subxiphoid Approach Leads to Less Invasive Thoracoscopic Thymectomy Than the Lateral Approach

  • Motoki YanoEmail author
  • Satoru Moriyama
  • Hiroshi Haneda
  • Katsuhiro Okuda
  • Osamu Kawano
  • Risa Oda
  • Ayumi Suzuki
  • Ryoichi Nakanishi
  • Hiroki Numanami
  • Masayuki Haniuda
Original Scientific Report with Video



Video-assisted thoracic surgery (VATS) is widely used in thoracic surgery. This study investigated the usefulness of the subxiphoid approach in thymectomy using VATS techniques.


Sixty operations were performed using the lateral approach (n = 46) and subxiphoid approach (n = 14). Using the lateral approach, 39 partial thymectomies (PT), 5 total or subtotal thymectomies (TT), and 2 total or subtotal thymectomies with combined resection of the surrounding organs (or tissues) (CR) were performed. Using the subxiphoid approach, 11 TT and 3 CR were performed.


There were 33 females and 27 males, with a mean age of 55 years. The mean maximum tumor diameter was 4.0 cm. The operation time was prolonged according to the volume of thymectomy (PT: 119, TT: 234, CR: 347 min). Additionally, the intraoperative blood loss increased according to the volume of thymectomy (PT: 29, TT: 47, CR: 345 g). To compare the invasiveness of both approaches, we compared 16 TT operations. In the group using the subxiphoid approach, the operation time became shorter (158 vs. 392 min), and the blood loss decreased (5 vs. 135 g) compared with the lateral approach. Regarding laboratory data, white blood cell counts on postoperative day 1 (1POD) (8200 vs. 10,300/μl) and CRP on 1POD and 3POD (2.8 and 2.8 vs. 7.9 and 10.2 mg/dl, respectively) decreased in the subxiphoid approach compared with the lateral approach.


The subxiphoid approach leads to a less invasive operation for anterior mediastinal tumors and extends the indications for VATS for invasive anterior mediastinal tumors.


Lateral Approach Thymoma Median Sternotomy Thymic Carcinoma Chest Tube Drainage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest in the present study. None of the contributors had interests to disclose with regard to commercial support.

Supplementary material

Supplementary material 1 (M4V 56283 kb)


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Motoki Yano
    • 1
    Email author
  • Satoru Moriyama
    • 2
  • Hiroshi Haneda
    • 2
  • Katsuhiro Okuda
    • 2
  • Osamu Kawano
    • 2
  • Risa Oda
    • 2
  • Ayumi Suzuki
    • 2
  • Ryoichi Nakanishi
    • 2
  • Hiroki Numanami
    • 1
  • Masayuki Haniuda
    • 1
  1. 1.Division of Chest Surgery, Department of SurgeryAichi Medical UniversityNagakuteJapan
  2. 2.Department of Oncology, Immunology and SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan

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