International Society For Minimally Invasive Cardiothoracic Surgery

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Subxiphoid Approach For Single Site Robotic Thymectomy
Kook Nam Han, Hyun Koo Kim, Jeong In Hong.
Korea University Guro Hospital, Seoul, Korea, Republic of.

OBJECTIVE: The surgical approach for robotic-assisted thymectomy has been evolved as the development of single port robotic devices. In this case, we introduce subxiphoid approach for single-site robotic thymectomy in conjunction with VATS to evaluate its safety and limitations.
METHODS: We performed subxiphoid approach for single site robotic thymectomy in a 61-year old female with thymic tumor at anterior mediastinum. The devices we used were an 8.5 mm endoscope, 5-mm non-wristed curved devices and a 3-cm diameter port device for single site robotic surgery.
RESULTS: We dissected anterior and upper medial mediastinal fat tissues with single site robotic system through subxiphoid approach. However, we could not approach mid to lower mediastinum with subxiphoid approach because there is limitation of working distance of robotic devices. So, we switched to VATS for mid to lower mediastinal fat dissection to expose anterior mediastinum with both pleural opening. After fully exposing anterior mediastinum, we could identify both phrenic nerves and vascular structures at upper mediastinum to proceed robotic thymectomy.
CONCLUSIONS: Potential benefits of this approach might be the better surgical accuracy and enhanced operative field during robotic thymectomy.

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