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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2005;130:912-913
© 2005 The American Association for Thoracic Surgery

Brief Communication

Preliminary experience with minimally invasive video-assisted surgery for thymic diseases, including myasthenia gravis, through a horizontal ministernotomy

Masazumi Watanabe, MD, PhD * , Ryohei Yozu, MD, PhD, Koichi Kobayashi, MD, PhD

Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.

Received for publication March 11, 2005; accepted for publication April 11, 2005.

* Address for reprints: Masazumi Watanabe, MD, PhD, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Email: masazumi@sc.itc.keio.ac.jp).

The first 20% of the full text of this article appears below.


Formula

Conventional surgery in the anterior mediastinum, including for myasthenia gravis (MG), is usually performed through a median sternotomy. Less invasive thoracoscopic 1,2 Go or subxyphoid 3,4 Go procedures, which usually require a bilateral thoracic or cervical approach, have recently been introduced. We have reviewed and present our early experience with extended thymectomy through a horizontal ministernotomy, a new surgical approach for thymic diseases, including MG.

Surgical Techniques

After achievement of general anesthesia with a standard endotracheal tube, the patient was positioned on the operating table in the supine position. An approximately 6-cm-long, horizontal cutaneous incision was made anteriorly at the level of the second intercostal space, and the sternum was traversed. The internal thoracic artery and vein were ligated and divided on one side when necessary. With the assistance of a special sternum retractor and video imaging, extended thymectomy was performed through the ministernotomy (Figure 1). The resected areas were on the ventral side of both phrenic nerves, extending from the thyrothymic ligaments to the diaphragm. The . . . [Full Text of this Article]






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