[Thymectomy via Trans-subxiphoid Approach].

Minimally invasive thoracoscopic thymectomy has been indicated in patients with non-invasive thymic epithelial tumors or myasthenia gravis. Sub-xiphoid thymectomy has an advantage of similar surgical view of median sternotomy as compare to lateral approach. Since anterior mediastinum is anatomically limited space, robotic approach with carbon dioxide (CO2) insufflation has led a drastic innovation in thymectomy. We introduced robotic subxiphoid-optical thymectomy (RST) and experienced 38 cases without open conversion, so far. RST contributes a sufficient surgical view for total and extended thymectomy with its fine dissection, especially around innominate vein. RST with combined resection of left brachiocephalic vein or pericardium was feasible. Postoperative pain evaluated using numeric rating scale was minimal and epidural anesthesia is not required. Furthermore, we herein describe thoracoscopic subxiphoid-optical thymectomy based on the RST for institutes where thoracic robotic surgery has not been adopted.