A median sternotomy is the time honored approach for resection of the thymus gland both for neoplasm and benign disease, such as myasthenia gravis. However, the scar from the vertical skin incision is less than optimal, particularly since the majority of myasthenic patients are young women for whom cosmesis is important. In this regard, a number of different solutions have been suggested such as an exclusive cervical approach, a cervico-sternotomic approach, a wide submammary or a limited vertical skin incision, and, most recently, thoracoscopic thymectomy. Methods. This paper describes the use of a total median sternotomy for thymectomy, performed through a 5-6 ems transverse cutaneous incision, at the level of the lower third of the sternum body. A wide cutaneous-subcutaneous flap is created from the sternal head of the sternocleidomastoidea to the xyphoid and, laterally, to the mid clavicular lines. Median total sternotomy, starting from the xyphoid allows a good exposure of the anterior media-stinum. Using a combined direct and videoassisted technique, a radical thymectomy is performed. The thoracoscope is used during the whole operation as an optimal source of light and becomes essential to perform some steps such as the identification of phrenic nerves, thymic veins and upper poles of the gland. Results. Since December 1992 this approach has been used successfully in a consecutive series of 52 patients, affected by myasthenia gravis (41 females-11 males, mean age: 26.8 yrs). All patients had documented 'anti AchE' antibodies, in I-II-III Ossermann class of disease and no thymic neoplasms detected by CT or MRI. No significant postoperative complications related to the technique were observed. Conclusions. This approach provides an excellent and well accepted cosmetic result while still offering the advantages of direct and video-assisted visualization of the thymus gland.
|Translated title of the contribution||Videoassisted sternotomic thymectomy with transverse supraxyphoid cutaneous incision|
|Number of pages||4|
|Publication status||Published - 1998|
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