title: Endoscopic robot-assisted extended thymectomy by subxiphoid approach with sternal lifting: feasibility in the pig.
abstract: BACKGROUND
  In the search for novel approaches to thoracoscopic thymectomy we assessed the feasibility of a subxiphoid approach using computer-enhanced instruments and sternal lifting.
  
  
  METHODS
  In 12 pigs, after lifting of the sternum, ports were placed subxiphoid (stereoscope) and in the left and right fourth intercostal space (instruments). Using computer-enhanced instruments, dissection of the thymus and anterior mediastinal fat pads was started at the diaphragm and continued cephalad.
  
  
  RESULTS
  After setup of the robot system (23 +/- 6 min, mean +/- SD), the thymus, including both superior horns, and fat pads in the anterior mediastinum and cardiophrenic angles were dissected (109 +/- 23 min), with excellent view of the phrenic nerves. Visual inspection after sternotomy after the procedure showed all thymic and fatty tissue was removed.
  
  
  CONCLUSIONS
  In the pig, endoscopic extended thymectomy can be safely performed by subxiphoid access using computer-enhanced instruments, sternal lifting, and three ports total.
authors.affiliation: Heart Lung Center Utrecht, University Medical Center G02.523, Post Office Box 85500, 3508, Utrecht, GA, The Netherlands. P.F.A.Bakker@hli.azu.nl
authors.forename: P F A
authors.initials: PF
authors.lastname: Bakker
authors.forename: R P J
authors.initials: RP
authors.lastname: Budde
authors.forename: P F
authors.initials: PF
authors.lastname: Gründeman
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D019060:Minimally Invasive Surgical Procedures; D023421:Models, Animal; D012371:Robotics; D013045:Species Specificity; D013249:Sternum; D025321:Surgery, Computer-Assisted; D013552:Swine / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D014743:Videotape Recording