title: Thoracoscopic thymectomy: technical pearls to a 21st century approach.
abstract: OBJECTIVE
  Thoracoscopic approaches to thymectomy have increased as imaging and instrumentation have advanced. Indications for the thoracoscopic approach are evolving. We reviewed our experience in the transition from sternotomy to thoracoscopy and have gleaned technical points to aid in performing thymectomy.
  
  
  METHODS
  The experience during the transition of sternotomy to thoracoscopy was reviewed.
  
  
  RESULTS
  THE FOLLOWING COMPONENTS HAVE BEEN OBSERVED TO BE ADVANTAGEOUS: (I) initial patient positioning is crucial; (II) thoracoscopy provides improved visualization (a separate camera setup can facilitate visualization of the left phrenic nerve); (III) CO2 aids in dissection; (IV) electrocautery and harmonic scalpel aid in dissection and hemostasis; (V) circumferential dissection identifies anatomic boundaries; (VI) endoscopic ligation of innominate vein branches is adequate; and (VII) minimal access techniques impart a shorter convalescence. In our transition, the length of stay has decreased from 4.3±2.9 to 2.3±1.2 days (P=0.0217).
  
  
  CONCLUSIONS
  We are routinely able to employ this thoracoscopic approach for complete removal of thymic tissue in patients with myasthenia gravis and those with small (<3 cm) thymic masses. A standard approach to dissection in thoracoscopic thymectomy streamlines the procedure and enables safe resection.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: Rafael S
authors.initials: RS
authors.lastname: Andrade
authors.forename: Mohi O
authors.initials: MO
authors.lastname: Mitiek
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Michael A
authors.initials: MA
authors.lastname: Maddaus
keywords: Video-assisted thoracoscopic surgery; minimally invasive; sternotomy; thymectomy