Previous experience using the transcervical, left or right thoracic approach for thymectomy, although demonstrating promising efficacy, involves some compromise of the surgical exposure. We performed subxiphoid video-assisted thoracoscopic extended thymectomy (SxVATET) on eight consecutive myasthenic patients. The mean operation time, weights of resected specimen, and thoracic drainage period were 156.9 min (range 120-200 min), 77.5 g (range 40-100 g), and 3.4 days (range 3-4 days), respectively. There were no surgical complications or mortalities, and the cosmesis is satisfying. Our experience demonstrates that SxVATET provides an excellent view of the bilateral pleural cavities. Subsequently, extended thymectomy, resecting ample mediastinal fatty tissue in addition to the thymic glands, can be safely undertaken.