Surgical tips to Improve Completeness of Trans-subxiphoid Robotic Extended Thymectomy

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.

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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

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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.

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Extended Thymectomy via Videothoracoscopy-assisted Stepwise-access Sternotomy

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.oa.10.01568 ◽

2011 ◽

Vol 17 (4) ◽

pp. 337-340

Author(s):

Takashi Iwata ◽

Takashi Yasuoka ◽

Shoji Hanada ◽

Yasuo Suehiro ◽

Masayuki Sakaki ◽

...

Keyword(s):

Extended Thymectomy

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Predictive factors of myasthenic crisis after extended thymectomy for patients with myasthenia gravis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezu530 ◽

2015 ◽

Vol 48 (5) ◽

pp. 705-709 ◽

Cited By ~ 21

Author(s):

Takeshi Ando ◽

Mitsugu Omasa ◽

Takayuki Kondo ◽

Tetsu Yamada ◽

Masaaki Sato ◽

...

Keyword(s):

Myasthenia Gravis ◽

Predictive Factors ◽

Myasthenic Crisis ◽

Extended Thymectomy

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Robotic Extended Thymectomy

Robotic Surgery ◽

10.1007/978-3-030-53594-0_33 ◽

2021 ◽

pp. 387-397

Author(s):

Feng Li ◽

Mahmoud Ismail ◽

Andreas Meisel ◽

Jens-C Rueckert

Keyword(s):

Extended Thymectomy

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Thymoma resection in a patient with a history of extended thymectomy for myasthenia gravis without thymoma

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.30.214 ◽

2016 ◽

Vol 30 (2) ◽

pp. 214-217

Author(s):

Yasuhiro Otsuki ◽

Kotaro Kameyama ◽

Tomoaki Matsuoka ◽

Kenji Kimura ◽

Norihito Okumura

Keyword(s):

Myasthenia Gravis ◽

Extended Thymectomy ◽

History Of

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Thymoma Associated with Pure Red-Cell Aplasia: Clinical Features and Prognosis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000213 ◽

2002 ◽

Vol 10 (2) ◽

pp. 150-154 ◽

Cited By ~ 23

Author(s):

Tomohiro Murakawa ◽

Jun Nakajima ◽

Hajime Sato ◽

Makoto Tanaka ◽

Shinichi Takamoto ◽

...

Keyword(s):

Myasthenia Gravis ◽

Clinical Features ◽

Surgical Intervention ◽

Pure Red Cell Aplasia ◽

The Other ◽

Entire Group ◽

Red Cell ◽

Extended Thymectomy ◽

Red Cell Aplasia

As information on the clinical features and prognosis of thymoma complicated by pure red-cell aplasia is limited, follow-up data on thymoma patients who had a thymectomy between 1954 and 1999 were analyzed retrospectively. Six of 166 cases were complicated by pure red-cell aplasia. In 3 of these, the pure red-cell aplasia appeared after surgical intervention. Remission was observed in 2 patients who underwent extended thymectomy. The other 4 patients subsequently died from pure red-cell aplasia. The outcome in patients with pure red-cell aplasia was poorer than that in the entire group of patients with thymoma and in those with thymoma complicated by myasthenia gravis. The possible onset of pure red-cell aplasia after thymectomy should be kept in mind during follow-up.

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