title: Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum.
abstract: OBJECTIVE
  To present the new technique of minimally invasive extended thymectomy performed through the subxiphoid-right video-thoracoscopic (VATS) approach with double elevation of the sternum and the early results of resection of thymomas with the use of this technique.
  
  
  METHODS
  
  
  
  METHODS
  whole dissection was performed through a 4- to 7-cm transverse subxiphoid incision, and a single 5-mm port was inserted into the right chest cavity for the video thoracoscope and subsequently for the chest tube. The sternum was elevated with two hooks connected to the sternal frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland). The lower hook was inserted through the subxiphoid incision, and the superior hook was inserted percutaneously after the mediastinal tissue including the major mediastinal vessels was dissected from the inner surface of the sternum. The fatty tissue of the anterior mediastinum and the aorta-pulmonary window was completely removed.
  
  
  RESULTS
  There were 24 patients operated on for the Masaoka Stage I-III thymoma in the period from 1 January 2009 to 30 March 2012. There was no mortality and complications occurred in 1 patient necessitating revision for bleeding (morbidity rate 4.2%). The median operative time was 105.0 (range 70-195) min. In 2 patients it was possible to completely resect Masaoka Stage III tumour infiltrating the right lung, which was resected with the use of an endostapler. The dimensions of the thymomas ranged from 1.8 × 1.5 × 1.5 to 12 × 9 × 5 cm.
  
  
  CONCLUSIONS
  In our opinion, the presented technique is probably the least invasive and the most complete technique of VATS thymectomy with excellent cosmetic results and is a valid alternative to sternotomy approach for the Masaoka Stage I-III thymomas.
authors.affiliation: Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland. marcinz@mp.pl
authors.forename: Marcin
authors.initials: M
authors.lastname: Zielinski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Czajkowski
authors.forename: Pawel
authors.initials: P
authors.lastname: Gwozdz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Nabialek
authors.forename: Artur
authors.initials: A
authors.lastname: Szlubowski
authors.forename: Juliusz
authors.initials: J
authors.lastname: Pankowski
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000601:surgery*; D014989:Xiphoid Bone / Q000601:surgery
keywords: Mediastinum; Thymectomy; Thymoma