National survey of endoscopic thymectomy: survey report from the Japanese Association for Research on the Thymus.

Currently, no specific item regarding endoscopic thymectomy for nonthymomatous myasthenia gravis is listed in the standards of deciding medical service fees. To understand the present situation regarding the medical fee-for-service for endoscopic thymectomy, a questionnaire survey was conducted involving the institutions and members participating in the Japanese Association for Research on the Thymus. Of 101 responding institutions, 18 (18%) reported basically performing endoscopic thymectomy in all qualifying patients, and 32% of the institutions reported mainly performing median sternotomy but sometimes performing endoscopic thymectomy. The methods of approaching endoscopic thymectomy varied among the institutions, but most included endoscopic clips or ultrasound-driven scalpels as well as anterior chest wall lifting devices. A total of 214 patients underwent thymectomy in 2004 in the responding institutions, of whom 77 patients (32%) underwent endoscopic thymectomy. In total, 71% of the responding institutions answered that a specific item regarding endoscopic thymectomy should be listed in the standards for deciding medical service fees.