Open Videoassisted Techniques: Subxiphoid Approach with Bilateral Thoracoscopy

Abstract

For more than 50 years, sternal splitting thymectomy has been the gold standard ever since Blalock first introduced thymectomy for treatment of myasthenia in 1939 [1]. Jaretzki [2] and Masaoka [3] have demonstrated varied distribution of ectopic thymic tissues in the mediastinum and the neck. They both recommend a more extensive resection of tissue beyond the thymic gland itself, using a transcervical-transsternal approach. Minimally invasive thymectomy was introduced by Yim et al. using a right thoracoscopic approach in the early 1990s [4]. Some concern regarding this minimally invasive approach was raised mainly due to questioning the limited exposure, limited working space, and completeness of extended thymectomy which could endanger the therapeutic results [2]. Though controversy surrounds the selection of operation for patients with myasthenia gravis, we developed a novel technique to perform extended thymectomy using video-assisted thoracoscopy by a subxiphoid bilateral approach in early 2001.