Objective To compare and analyze clinical effects of extended thymectomy for the treatment of thymoma with myasthenia gravis(MG) between subxiphoid and subcostal arch thoracoscopic resection(SR) and the median sternotomy(MS) with a propensity-matched analysis.Methods We retrospectively analyzed 528 patients presented with MG and admitted in Tangdu Hospital of Air Force Military Medical University from December 2011 to December 2016,among whom 402 underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy(SR group) and 126 median sternotomy(MS group).Another 126 patients were produced by a propensity-matched analysis in these 402 patients,to match with MS group.Perioperative outcomes were compared between SR group and MS group.Results All operations were accomplished successfully,without conversion to thoracotomy in SR group.Most postoperative outcomes were equal in remission of MG and postoperative complication between the two groups(P ＞ 0.05).There were statistical differences between MS group and SR group in operation time [(106.3 ±32.7)min vs.(533.2 ±37.3) min],intraoperative blood loss[(138.2 ±26.7)ml vs.(38.2 ± 10.3) ml],chest drainage duration[(3.3 ± 1.6) days vs.0 day],hospital length of stay [(5.0 ± 2.5) days vs.(2.5 ± 1.8) days],patients'satisfaction level(6.1 ±2.3 vs.8.9 ± 1.2),the incidence of postoperative wound infections(4.8％ vs.0.8％),the incidence of myasthenic crisis(7.1％ vs.1.6％)and pain scores,all P ＜0.05.Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for tmanagement of MG with thymoma.

Objective    To evaluate the clinical outcomes of harmonic scalpel in subxiphoid and subcostal arch approach for resection of anterior mediastinal lesion. Methods    We retrospectively analyzed the clinical data of 217 patients with anterior mediastinal lesion at the Department of Thoracic Surgery of Tangdu Hospital of the Fourth Military Medical University from June 2015 to June 2017, among whom 162 underwent thoracoscopic surgery via subxiphoid and subcostal arch approach with harmonic scalpel (a harmonic scalpel group, 95 males and 67 females at an average age of 46.2±18.7 years ranging from 22 to 72 years) and 55 with Ligasure (a Ligasure group, 29 males and 26 females at an average age of 47.7±12.9 years ranging from 31 to 68 years). Operation time, intraoperative blood loss, intraoperative conversion rate, postoperative hospital stay, patients satisfaction score, patients pain score and postoperative complications were compared between both groups. Results    All operations were accomplished successfully, and there was no death or conversion to thoracotomy. There was a statistical difference in operation time (58.6±34.8 min vs. 72.8±32.6 min, P=0.01), and intraoperative blood loss (36.2±18.7 ml vs. 41.9±12.9 ml, P=0.04). There was no statistical difference between the two groups in length of hospital stay (4.2±2.6 d vs. 4.5±1.9 d, P=0.36), pain score at postoperative day 1, 3 and 30 (8.3±0.9 vs. 8.5±0.6, P=0.13; 6.4±1.5 vs. 6.9±1.1, P=0.19; 1.3±0.7 vs. 1.4±0.9, P=0.40), patients’ satisfaction score (8.6±1.2 vs. 8.4±1.7, P=0.34), or incidence of postoperative complications (5.6% vs. 9.1%, P=0.35). Conclusion    Har-monic scalpel plays an important role in resection of anterior mediastinal lesion via subxiphoid and subcostal arch approach. All tissues are separated and blood vessels are dissected only by the harmonic scalpel, so it is very important for   us to handle the harmonic scalpel skillfully.

Objective    To compare clinical effects of enlarged thymectomy for the treatment of myasthenia gravis (MG) complicated with thymoma via subxiphoid and subcostal arch thoracoscopic resection versus median sternotomy resection. Methods    We retrospectively analyzed the clinical data of patients with MG complicated with thymoma admitted in Tangdu Hospital of the Air Force Military Medical University between December 2011 and December 2021. Patients who underwent subxiphoid and subcostal arch thoracoscopic enlarged thymectomy were allocated to a SR group, and patients who underwent median sternotomy enlarged thymectomy were allocated to a MR group. Perioperative outcomes were compared between the two groups. Results    A total of 456 patients were collected. There were 51 patients in the MR group, including 30 males and 21 females aged 23-66 (49.5±11.8) years. There were 405 patients in the SR group, among whom 51 patients were matched to the MR group by propensity score matching, including 28 males and 23 females aged 26-70 (47.2±12.2) years. The operations were accomplished successfully in all patients, and no conversion to thoracotomy occurred in the SR group. The SR group had advantages in the operation time, intraoperative blood loss,  chest drainage duration, hospital stay time, patients’ satisfaction level, pain score and complications (all P<0.05). No statistical difference was found in the number of intraoperative lymph node dissection stations, number of intraoperative lymph nodes dissected or remission of MG between the two groups (P>0.05). Conclusion    Subxiphoid and subcostal arch thoracoscopic enlarged thymectomy and lymphadenectomy is a safe, effective and feasible minimally invasive procedure for the treatment of MG complicated with thymoma.

Objective    To compare clinical effects of extended thymectomy for the treatment of thymic abnormalities with myasthenia gravis (MG) between subxiphoid and subcostal arch thoracoscopic resection (SR) and the unilateral thoracoscopic resection (UR) by a propensity-score matching analysis. Methods    We retrospectively analyzed the clinical data of 612 patients who presented with MG and were admitted to Tangdu Hospital of Air Force Military Medical University between December 2011 and December 2018. Of these patients, 520 patients underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy (a SR group) and 92 unilateral thoracoscopic extended thymectomy (a UR group). Ninety-two patients in the SR group were matched with the UR group by propensity-score matching analysis. There were 52 males and 40 females with an average age of 26-70 (50.2±10.3) years in the SR group, and 47 males and 45 females with an average age of 20-73 (51.5±12.1) years in the UR group. The operation time, intraoperative blood loss, thoracic drainage time, postoperative hospital stay, thorough adipose tissue removal, postoperative remission of MG, patients’ satisfaction score, pain and complications were compared and analyzed between the two groups. Results    All operations were accomplished successfully, without conversion to thoracotomy of the two groups. There were statistical differences between the two groups in operation time (46.2±19.5 min vs. 53.4±23.5 min), chest drainage duration (0 d vs. 3.4±1.2 d), hospital stay (2.9±1.9 d vs. 3.6±1.7 d), patients’ satisfaction score (7.9±2.1 points vs. 6.7±1.2 points) and pain scores (all P<0.05). There were no statistical differences between the two groups in intraoperative blood loss (52.2±12.7 mL vs. 51.2±10.3 mL), peripheral adipose tissue removal (8.1±0.6 vs. 7.9±0.9), remission rate of MG (89.1% vs. 85.9%) and rate of postoperative complications (10.9% vs. 6.5%) (all P>0.05). Conclusion    Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for the management of MG with thymic abnormalities.