Subxiphoid VATS approach for the mediastinum
The technique of subxiphoid video-assisted thoracoscopic surgery (VATS) approach for thymectomy for thymomas, non thymomatous myasthenia gravis and rethymectomies is described. This technique combines a subxiphoid incision with bilateral insertion of single intercostal, or subcostal VATS ports and elevation of the sternum with two hooks connected to the Rochard frame. The extended thymectomy is performed with opening of both pleural cavities, visualization of both phrenic nerves and the lower poles of the thyroid gland and en bloc removal of the whole thymus, parathymic fatty tissue, both epiphrenic fat pad and the sheets of right and left anterior mediastinal pleura covering the thymus and mediastinal fatty tissue. The variants of the subxiphoid VATS approach for the mediastinum and the applications of this approach are described.