Open Videoassisted Techniques: Subxiphoid Approach with Bilateral Thoracoscopy

  • Chung-Ping Hsu
  • Cheng-Yen Chuang


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.


Complete Remission Rate Xiphoid Process Thymic Cyst Extended Thymectomy Subxiphoid Approach 
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© Springer-Verlag Italia 2008

Authors and Affiliations

  • Chung-Ping Hsu
    • 1
  • Cheng-Yen Chuang
    • 2
  1. 1.Department of Surgery Division of Thoracic SurgeryTaichung Veterans General HospitalTaichungTaiwan, ROC
  2. 2.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan, ROC

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