Subxiphoid thymectomy: single-port, dual-port, and robot-assisted

Currently, surgical techniques that are less invasive than conventional median sternotomy are used for thymectomy in the treatment of myasthenia gravis and anterior mediastinal tumors as no sternal incision is required. We reported on a subxiphoid single-port thymectomy using CO2 insufflation, which has the following advantages: (I) the field of view offered by the camera scope inserted from the midline of the body helps confirm the location of the superior pole of the thymus and bilateral phrenic nerves; (II) there is minimal pain and no intercostal neuropathy occurs as intercostal spaces are not traversed; and (III) cosmetic outcomes are excellent. However, a drawback of this approach is that it requires familiarity with the single-port surgical procedure. Various surgical modifications have been suggested for the subxiphoid approach, which we currently use for thymectomy. These include subxiphoid single-port thymectomy; subxiphoid dual-port thymectomy (DPT) wherein an additional lateral thoracic intercostal port is added, which is used for more complicated surgeries; and subxiphoid robotic thymectomy using the da Vinci Surgical System. Here we report on these techniques. A subxiphoid approach in thymectomy is advantageous to patients as it minimizes or avoids the occurrence of intercostal neuropathy. Moreover, a subxiphoid approach provides the surgeon with a good field of view of the cervical region and helps confirm the location of the bilateral phrenic nerves. Therefore, thymectomy using a subxiphoid approach should be considered an option for a minimally invasive surgery.