Outcome of an Original Video-Assisted Thoracoscopic Extended Thymectomy for Thymoma

Absztrakt Célkitűzés: A myasthenia gravis (MG) kezelésében számos nyitott, illetve minimálisan invazív thymectomia ismert. A tanulmány ugyanazon intézeten belül a transsternalis (TS), illetve kétféle minimálisan invazív thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredményeit hasonlítja össze. Anyag és módszerek: Három különböző időintervallumban 71 betegnél történt thymectomia MG miatt (60 nő, 11 férfi): 23 transsternalis thymectomia (1995. január–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) és 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmények értékelésénél a műtéti idő, MG-hez társuló neurológiai és a műtét utáni sebészi szövődmények, valamint az MG státuszában az egyéves utánkövetéskor észlelt neurológiai változások szerepeltek. Eredmények: Perioperatív mortalitás nem fordult elő. A műtéti idő 112, 211, 116 perc (p = 0,001), a kórházi napok száma: 8,9, 5,6 és 4 nap (p = 0,001) volt a TS-, VATET- és UL-VATS-csoportban. Az MG-hez kapcsolódó postoperativ neurológiai szövődmények 21,7%, 18,2% és 7,7% (p = 0,365) értékeket mutattak. A sebészi szövődmény 4,3%, 13,7%, 0% (p = 0,118) volt. Az MG tüneteinek javulása 91,3%, 94,7%, 87,5% (p = 0,712), míg komplett remisszió 13%, 10,5%, 11,5% (p = 0,917) volt a TS-, VATET- és UL-VATS-csoportokban. Következtetések: A műtéti idő, valamint a kórházban eltöltött napok száma UL-VATS esetében volt a legrövidebb. A kisebb sebészi beavatkozáshoz alacsonyabb sebészi, illetve MG-s neurológiai szövődmények társultak. Az MG-tünetek javulásában mindhárom módszernél kiváló eredményt értek el.

Download Full-text

Extended rethymectomy in the treatment of refractory myasthenia gravis: original video-assisted technique of resternotomy and results of the treatment in 21 patients

Interactive Cardiovascular and Thoracic Surgery ◽

10.1016/j.icvts.2004.02.008 ◽

2004 ◽

Vol 3 (2) ◽

pp. 376-380 ◽

Cited By ~ 15

Author(s):

M Zielinski

Keyword(s):

Myasthenia Gravis ◽

Original Video ◽

Video Assisted

Download Full-text

Transcervical excision of thymoma and video-assisted thoracoscopic extended thymectomy (VATET) for ectopic cervical thymoma with myasthenia gravis: report of a case

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-015-0582-3 ◽

2015 ◽

Vol 64 (12) ◽

pp. 752-754 ◽

Cited By ~ 2

Author(s):

Sachiko Kumazawa ◽

Hironori Ishibashi ◽

Ken Takahashi ◽

Kenichi Okubo

Keyword(s):

Myasthenia Gravis ◽

Extended Thymectomy ◽

Video Assisted

Download Full-text

Video-assisted thoracoscopic extended thymectomy in myasthenic children

Pediatric Reports ◽

10.4081/pr.2013.e4 ◽

2013 ◽

Vol 5 (1) ◽

pp. 4 ◽

Cited By ~ 1

Author(s):

Rita Sonzogni ◽

Lorenzo Novellino ◽

Alberto Benigni ◽

Ilaria Busi ◽

Magda Khotcholava ◽

...

Keyword(s):

Case Reports ◽

Preoperative Evaluation ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Ventilator Weaning ◽

New Drugs ◽

Extended Thymectomy ◽

Myasthenic Patient ◽

Surgical Department ◽

Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

Download Full-text

Video-Assisted Extended Transcervical Thymectomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31803c9b45 ◽

2007 ◽

Vol 2 (2) ◽

pp. 90-94 ◽

Cited By ~ 2

Author(s):

Christopher B. Komanapalli ◽

James I. Cohen ◽

Mithran S. Sukumar

Keyword(s):

Lung Ventilation ◽

Complete Resection ◽

Extended Thymectomy ◽

Single Lung Ventilation ◽

Superior Mediastinum ◽

Video Assisted

Objective The objective of this study was to demonstrate extended thymectomy via the transcervical route. Methods With the use of the Rultract retractor (Rultract, Cleveland, OH), videothoracoscopy and single-lung ventilation allowed complete thymectomy. Results This article demonstrates complete resection of all the thymus from the anterior and superior mediastinum. Conclusions In selected patients, the transcervical route can used to completely resect the thymus, avoiding the morbidity of sternotomy.

Download Full-text

Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: remission after 6 years of follow-up

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(03)00087-x ◽

2003 ◽

Vol 212 (1-2) ◽

pp. 31-36 ◽

Cited By ~ 82

Author(s):

Renato Mantegazza ◽

Fulvio Baggi ◽

Pia Bernasconi ◽

Carlo Antozzi ◽

Paolo Confalonieri ◽

...

Keyword(s):

Myasthenia Gravis ◽

Extended Thymectomy ◽

Video Assisted

Download Full-text

Two-Lung Ventilation: A Safer and More Efficient Method Than One-Lung Ventilation in Bilateral Video-Assisted Thoracoscopic Extended Thymectomy in Myasthenia Gravis

10.21203/rs.3.rs-133013/v1 ◽

2021 ◽

Author(s):

Mijung Yun ◽

Gunn Hee Kim ◽

Sung-chul Ko ◽

Wooshik Kim

Keyword(s):

Myasthenia Gravis ◽

Lung Ventilation ◽

One Lung Ventilation ◽

Extended Thymectomy ◽

Time Points ◽

Video Assisted ◽

Hemodynamic Variables ◽

Duration Of Surgery ◽

Anesthesia Time ◽

Group D

Abstract Background Myasthenia gravis (MG) is an autoimmune disease and early thymectomy has been recommended. After the introduction of VATS, the safety and effectiveness of carbon dioxide (CO2) insufflation in thoracic cavity (capnothorax) has been continuously controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax.Methods We retrospectively investigated the medical records of MG patients who underwent BVET between August 2016 and January 2018.Patients were divided into two groups: group D (n=26) for one-lung ventilation and group S (n=28) for two lung-ventilation. We set nine anesthesia time points (T0–T8) and collected respiratory and hemodynamic variables including arterial O2 index (PaO2/FiO2).Results The EtCO2 at T0, T1–T4, and T7 were insignificantly higher in group D than those in group S. The SpO2 at T1–T3 and T8 were significantly lower in group D than those in group S. The FiO2 in group S was lower than that in group D at all-time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 were significantly higher in group D than those in group S. Hemodynamic variables were not insignificantly different between the two groups at all-time points. The duration of surgery and anesthesia was shorter in group S than that in group D. Conclusions This retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax was a safe and effective method to improve lung oxygenation and reduce the operation and anesthesia time.

Download Full-text