title: Trans-subxiphoid robotic thymectomy.
abstract: Minimally invasive surgery has replaced median sternotomy for resectable anterior mediastinal masses and is performed by various approaches. We developed a new minimally invasive surgical procedure by combining the subxiphoid approach performed through a midline camera port with the use of a robotic surgery system (Intuitive Surgical, Sunnyvale, CA, USA). A 3-cm transverse incision was made 1 cm below the xiphoid process. Then, a port designed for single-port surgery was inserted. Through this port, CO2 gas was injected at 8 mmHg. The thymus was then detached from the back of the sternum. A 1-cm skin incision was made bilaterally in the sixth intercostal space, followed by insertion of a port for the robotic system. A camera port was inserted into the subxiphoid port, to which the camera scope was mounted, and thymectomy was performed. We have performed the operation in 3 patients. In our experience, this procedure provides a good operative view in the neck region and makes verification of the phrenic nerve easy. Furthermore, with the da Vinci surgical system, which enables surgical manipulation from a correct angle due to the multijoint robotic arms, trans-subxiphoid robotic thymectomy may be a promising new thymectomy procedure.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan suda@fujita-hu.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Suda
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tochii
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Tochii
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D065287:Robotic Surgical Procedures / Q000379:methods*; D012494:Sampling Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013934:Thymectomy / Q000379:methods*; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014989:Xiphoid Bone / Q000601:surgery*
keywords: Minimally invasive surgery; Robotics; Thoracoscopy/Video assisted thoracic surgery; Thymectomy