Technique of transcervical--subxiphoid-vats "maximal" thymectomy in treatment of myasthenia gravis.

Operative technique of transcervical-subxiphoid-VATS thymectomy is described. Total sternotomy is avoided which makes the procedure less invasive without compromising its radicality. The operation is performed with aid of special device with two sternal retractors elevating the sternum from above and below and facilitating access to the mediastinum. The mediastinal pleura is incised bilaterally and exenteration of the mediastinal fat is done under control of video camera inserted through the thoracoscopic ports. Two team approach is proposed: one team, called "the cervical" team performs dissection of the neck and the superior mediastinum; the "subxiphoid" team removes the fat tissue of the anterior mediastinum. This approach makes possible reduction of the operative time to 1.5-2 h. No complications were noted in the group of 8 patients operated on by the moment of submission of the abstract.