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Subxiphoid approach for thoracoscopic thymectomy.

机译:剑突下方法用于胸腔镜胸腺切除术。

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摘要

Avoiding sternotomy, cumulative experience has demonstrated the efficacy and safety of minimally invasive thoracoscopic thymectomy. Previous reports describing the transcervical, left or right thoracic approach, although demonstrating promising results, involve some compromise of the surgical exposure. We designed a new approach through the subxiphoid route to perform extended thymectomy using the standard thoracoscopic technique. We used this approach on two consecutive patients. Additional port sites were created on both sides of the anterior chest wall for introducing instruments. This approach provides an excellent view of the bilateral pleural cavities, which is essential for adequate mediastinal fatty tissue dissection, especially because the surgical plan calls for removal of all the bilateral pericardiophrenic fat pads and the mediastinal fat tissue between the bilateral phrenic nerves. This approach omits the sternotomy while making extended thymectomy possible through the bilateral access. All the possible thymic-bearing mediastinal fat tissues can be removed under direct thoracoscopic view, which may subsequently translate into better results.
机译:避免胸骨切开术,积累的经验证明了微创胸腔镜胸腺切除术的有效性和安全性。先前描述经颈,左或右胸腔入路的报道虽然显示出令人鼓舞的结果,但涉及外科手术暴露的一些折衷。我们设计了一种通过剑突下途径的新方法,以使用标准胸腔镜技术进行扩展胸腺切除术。我们对两名连续患者使用了这种方法。在前胸壁的两侧都创建了其他端口部位,以引入器械。这种方法可以很好地观察双侧胸膜腔,这对于进行足够的纵隔脂肪组织解剖是必不可少的,特别是因为手术计划要求去除所有双侧心包性脂肪垫和双侧phr神经之间的纵隔脂肪组织。这种方法省去了胸骨切开术,同时通过双侧入路使扩大胸腺切除成为可能。可以直接在胸腔镜下切除所有可能的带有胸腺的纵隔脂肪组织,随后可以转化为更好的结果。

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