title: Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results†.
abstract: OBJECTIVE
  Compared with conventional median sternotomy, approaches used in thymectomy for myasthenia gravis and anterior mediastinal tumours have become much less invasive in recent years. We previously developed a surgical technique called single-port thymectomy (SPT) to excise the thymus through a single opening made below the xiphoid process. In this study, to show the utility of SPT, we compared factors contributing to low surgical invasiveness between SPT and conventional video-assisted thoracoscopic surgery (VATS) thymectomy.
  
  
  METHODS
  Between January 2005 and December 2014, 146 patients underwent surgery for anterior mediastinal tumour or myasthenia gravis at our hospital. After excluding patients diagnosed with tumour invasion of nearby organs or those who had undergone concurrent removal of nearby organs, 81 patients were enrolled in this retrospective study as subjects. Patients were divided into the VATS thymectomy group (VATS group, n = 35) and the SPT group (n = 46). Surgical duration, blood loss, duration of hospital stay and the amount and duration of postoperative oral analgesics were compared between the groups.
  
  
  RESULTS
  Operating time did not vary significantly between the VATS and SPT groups (P = 0.0853). The amount of blood loss was higher in the VATS group than in the SPT group (P < 0.0001). The duration of hospital stay was longer in the VATS group than in the SPT group (P = 0.0008). The amount of postoperative oral analgesics was significantly higher in the VATS group than in the SPT group (P = 0.0092). Similarly, the duration of postoperative oral analgesics was significantly longer in the VATS group than in the SPT group (P = 0.0312).
  
  
  CONCLUSIONS
  Compared with VATS thymectomy, SPT required a similar operating time, was associated with less blood loss and enabled postoperative analgesics to be discontinued earlier. Therefore, it could be considered a less invasive surgical approach.
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: Ayumi
authors.initials: A
authors.lastname: Hachimaru
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: Ryo
authors.initials: R
authors.lastname: Maeda
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; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000601:surgery*; D013953:Thymus Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Single-port; Subxiphoid approach; Thymectomy; Video-assisted thoracoscopic surgery