Vats Sub Xiphoid Thymectomy: Why Should It Be The Default Access?
Khalid Amer, FRCS(C Th).
Southampton General Hospital, Southampton, United Kingdom.
OBJECTIVE: The sub-xiphoid access to the thymus gland is becoming more popular. We describe in this video clip the difficulty of having to approach a median line structure via right or left chest, and how a median approach saves the day.
METHODS: Practical steps of how to perform a triportal median access to the thymus, centred around a subxiphoid incision.
RESULTS: Triportal sub-xiphoid median approach is feasible for surgeons who like to operate via 3 ports. We managed to avoid going through either right or left chests in a patient with idiopathic severe pleural adhesions. Conventional right or left chest VATS approach would have been disastrous in such a patient, and conversion by sternotomy would have been the only available option.
CONCLUSIONS: Median structures require median access. Our sub-xiphoid triportal access to the thymus is one way of completely avoiding approach via right or left chest cavity.
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