Invited Commentary

Abstract

Invited commentaryThe extended thymectomy (ET) in which the thymus and fat tissue in anterior mediastinum are resected entirely, is now the standard operative method for MG. This means that it is more effective for MG, as the thymus tissue is resected more perfect. Recently, endoscopic surgery advanced and it is discussed whether ET is possible by the endoscope or not. Endoscopic thymectomy is inferior to ET by sternal splitting, because in endoscopic surgery, the resection of the fat tissue behind the left brachiocephalic vein is difficult and becomes imperfect even in the first operation. But surgical invasion is less in endoscopic surgery than in sternal splitting method.In this paper, completion thymectomy by endoscope is proposed. In some cases, there is insular residual thymic tissue in addition to massive thymic tissue detected by CT. Usually diffuse and tight adhesion was found in anterior mediastinum in reoperation. So, it is difficult to resect completely the insular thymic tissue by endoscopic surgery.I am afraid that completion thymectomy by endoscope is uncertain method. The dissection of adhesion of brachiocephalic vein by endoscope is dangerous. When the first operation was carried out carefully, the pneumomediastinum is difficult because of the diffuse adhesion. If the pneumomediastinum was performed successfully, we can not say that the patient underwent thymectomy in the first operation. Such a patient can be a candidate for the completion thymectomy by endoscope. Invited commentaryThe extended thymectomy (ET) in which the thymus and fat tissue in anterior mediastinum are resected entirely, is now the standard operative method for MG. This means that it is more effective for MG, as the thymus tissue is resected more perfect. Recently, endoscopic surgery advanced and it is discussed whether ET is possible by the endoscope or not. Endoscopic thymectomy is inferior to ET by sternal splitting, because in endoscopic surgery, the resection of the fat tissue behind the left brachiocephalic vein is difficult and becomes imperfect even in the first operation. But surgical invasion is less in endoscopic surgery than in sternal splitting method.In this paper, completion thymectomy by endoscope is proposed. In some cases, there is insular residual thymic tissue in addition to massive thymic tissue detected by CT. Usually diffuse and tight adhesion was found in anterior mediastinum in reoperation. So, it is difficult to resect completely the insular thymic tissue by endoscopic surgery.I am afraid that completion thymectomy by endoscope is uncertain method. The dissection of adhesion of brachiocephalic vein by endoscope is dangerous. When the first operation was carried out carefully, the pneumomediastinum is difficult because of the diffuse adhesion. If the pneumomediastinum was performed successfully, we can not say that the patient underwent thymectomy in the first operation. Such a patient can be a candidate for the completion thymectomy by endoscope. The extended thymectomy (ET) in which the thymus and fat tissue in anterior mediastinum are resected entirely, is now the standard operative method for MG. This means that it is more effective for MG, as the thymus tissue is resected more perfect. Recently, endoscopic surgery advanced and it is discussed whether ET is possible by the endoscope or not. Endoscopic thymectomy is inferior to ET by sternal splitting, because in endoscopic surgery, the resection of the fat tissue behind the left brachiocephalic vein is difficult and becomes imperfect even in the first operation. But surgical invasion is less in endoscopic surgery than in sternal splitting method. In this paper, completion thymectomy by endoscope is proposed. In some cases, there is insular residual thymic tissue in addition to massive thymic tissue detected by CT. Usually diffuse and tight adhesion was found in anterior mediastinum in reoperation. So, it is difficult to resect completely the insular thymic tissue by endoscopic surgery. I am afraid that completion thymectomy by endoscope is uncertain method. The dissection of adhesion of brachiocephalic vein by endoscope is dangerous. When the first operation was carried out carefully, the pneumomediastinum is difficult because of the diffuse adhesion. If the pneumomediastinum was performed successfully, we can not say that the patient underwent thymectomy in the first operation. Such a patient can be a candidate for the completion thymectomy by endoscope.