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Uniportal Subxiphoid VATS thymectomy
Giuseppe Aresu, MD, PhD, Gianluca Masullo, MD, Francesco Londero, MD, Angelo Morelli, MD.
Santa Maria della Misericordia University Hospital Udine, Udine, Italy.

OBJECTIVE: The aim of this video is to show the feasibility of extended thymectomy through a uniportal subxiphoid port as alternative to other minimal invasive anterior mediastinal approaches.
METHODS: We operate a 51 years old female presenting a thymoma of 2.5 cm and myasthenia gravis.
A 3.5-cm longitudinal muscle sparring incision was made below the xiphoid process through the linea alba. A trocar designed for Single Incision Laparoscopic Surgery was inserted into the port and CO2 was insufflated at a maximal pressure of 8 mm Hg. Under visual guidance provided through a 10-mm variable angle Telescope the dissection was carried out using grasping forceps designed for single-incision surgery, an ultrasonic dissection device and a normal straight hook cautery. The bilateral phrenic nerves and the bilateral mammary arteries and veins were always under optimal control as well as the cranial part of the mediastinum permitting a safe dissection en bloc of the thymus, thymic tumor, and surrounding fatty tissue anterior to the phrenic nerves. The operation time was about 2 hours and 36 minutes with minimal blood loss.
RESULTS: No complications occurred during or after the operation, the drain was taken out after one day and the patient was discharged home 2 days after surgery. Postoperative pain was very well controlled with just 1g x 3 daily of paracetamol till the second post operative day.
CONCLUSIONS: The subxhyphoid approach for thymectomy permits a very radical and safe dissection of the thymic and peri-thymic fatty tissues and can be considered as safe, esthetically excellent and less painful minimally invasive approach even when compared to conventional intercostal vats approaches.

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