title: Thymectomy via a subxiphoid approach: single-port and robot-assisted.
abstract: BACKGROUND
  We have previously reported on single-port thymectomy (SPT), which involves performing thymectomy via a single subxiphoid incision, and trans-subxiphoid robotic thymectomy (TRT), which is performed using the da Vinci surgical system. The aim of this study was to investigate the early surgical outcomes of thymectomy using the SPT and TRT subxiphoid approaches and to discuss their appropriate uses.
  
  
  METHODS
  The subjects included 80 patients who underwent thymectomy via a subxiphoid approach. These patients were selected from among 99 surgical cases of myasthenia gravis or anterior mediastinal tumors at Fujita Health University Hospital between March 2011 and November 2015. The patients were divided into a SPT group (n=72) and a TRT group (n=8).
  
  
  RESULTS
  The operative time was shorter in the SPT group compared with that in the TRT group (135±48 and 20±40 min, respectively; P=0.0004). There were no significant differences between the groups in terms of blood loss volume (5.9±16.8 and 5.4±4.6 mL, respectively; P=0.48), postoperative hospital stay duration (4.0±2.0 and 4.3±3.6 days, respectively; P=0.21), or the period of postoperative oral analgesic use (10.7±5.4 and 10.1±3.4 days, respectively; P=0.89). There were no intraoperative complications, such as intraoperative bleeding, in either group. In the SPT group, there was one case (1.4%) of postoperative left phrenic nerve paralysis and one case (1.4%) of transient paroxysmal atrial fibrillation. No one died during or after the surgery.
  
  
  CONCLUSIONS
  TRT may be as equally minimally invasive as SPT. In cases where the thymoma has infiltrated the surrounding organs, the extent of the infiltration should be used to determine whether to select TRT, or median sternotomy.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Suda
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kaneda
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Hachimaru
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tochii
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Maeda
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Tochii
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake, Toyoake, Aichi 470-1192, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
keywords: Thymectomy; minimally invasive surgery; robotics; thoracoscopy/VATS