BENEFITS OF THYMECTOMY IN MYASTHENIA GRAVIS

In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia,there was no relationship between age and gender in remission with thymectomy. In MG treatment,randomized trials that compare conservative treatment with thymectomy have started,recently.As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication.There are four major methods for the surgical approach:transcervical,minimally invasive,transsternal,and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods.There are not any randomized, controlled studies which are comparing surgical techniques.However,when comparing non-randomized trials,it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.

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Life-threatening spontaneous hematoma of the chest wall treated with packing and delayed chest closure

10.36811/osjs.2019.110001 ◽

2019 ◽

pp. 01-03

Author(s):

Francesco Mongelli ◽

Francesco Proietti ◽

Miriam Patella ◽

Stefano Cafarotti

Keyword(s):

Conservative Treatment ◽

Minimally Invasive ◽

Surgical Intervention ◽

Endovascular Embolization ◽

Minimally Invasive Techniques ◽

Life Threatening ◽

Thoracic And Abdominal ◽

Invasive Techniques ◽

Anticoagulated Patients ◽

Spontaneous Hematoma

Bleeding of the thoracic and abdominal wall most commonly occur in anticoagulated patients [1]. The management is based on anticoagulant therapy reversal which is mostly effective [2]. If conservative treatment is insufficient, good results are provided by endovascular embolization techniques [2,3]. The need of surgical intervention is extremely rare and limited to cases in which minimally invasive techniques are unsuccessful or somehow contraindicated [4].

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Spontaneous intracranial haematoma

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0054 ◽

2019 ◽

pp. 643-650

Author(s):

Berk Orakcioglu ◽

Andreas W. Unterberg

Keyword(s):

Minimally Invasive Surgery ◽

Surgical Treatment ◽

Conservative Treatment ◽

Minimally Invasive ◽

Invasive Surgery ◽

High Morbidity ◽

Intracranial Haematoma ◽

Randomized Controlled ◽

Randomized Controlled Studies

Spontaneous intracranial haematomas remain a challenging pathology with high morbidity and mortality (60–80% of long-term disability). Despite decades of the search for specific treatments no evidence has yet been found for neither conservative nor surgical treatment in randomized controlled studies. While patients with space occupying infratentorial haematomas are more likely to benefit from surgery treatment of supratentorial haemorrhages remains controversial. Recent studies suggest that minimally invasive surgery including endoscopy to evacuate intracranial haematoma may be more effective than conservative treatment or standard surgical craniotomy (MISTIE II). Future studies (i.e. MISTIE III, MISTICH, SWITCH) will hopefully demonstrate evidence for individualized treatments.

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Minimally Invasive Evaluation and Treatment of Colorectal Liver Metastases

International Journal of Surgical Oncology ◽

10.1155/2011/686030 ◽

2011 ◽

Vol 2011 ◽

pp. 1-12

Author(s):

Anton L. Gueorguiev ◽

Richard Mackey ◽

Gopal C. Kowdley ◽

Jesus Esquivel ◽

Steven C. Cunningham

Keyword(s):

Minimally Invasive ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Randomized Trials ◽

Ablation Therapy ◽

Surgeon Training ◽

Laparoscopic Techniques ◽

Major Hepatectomies ◽

Invasive Techniques ◽

Invasive Evaluation

Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.

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Systematic Review and Network Meta-Analysis of Randomized Trials of Surgery and Minimally Invasive Techniques Versus Cyanoacrylate Embolization for Varicose Veins

Value in Health ◽

10.1016/j.jval.2018.07.519 ◽

2018 ◽

Vol 21 ◽

pp. S68-S69

Author(s):

JK Chung ◽

S Kim ◽

J Zygmunt ◽

A Watercott ◽

R Periyasamy

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Randomized Trials ◽

Varicose Veins ◽

Meta Analysis ◽

Minimally Invasive Techniques ◽

Invasive Techniques

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“Maximal” minimally invasive thymectomy in patients with Nonthymomatous Myasthenia Gravis – short-term results over a 10year period – retrospective study

Perspectives in Surgery ◽

10.33699/pis.2020.99.5.226-231 ◽

2020 ◽

Vol 99 (5) ◽

pp. 226-231

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Learning Curve ◽

Myasthenia Gravis ◽

Short Term ◽

Multicentric Study ◽

Modified Method ◽

Minimally Invasive Surgical ◽

Double Blinded ◽

Invasive Techniques

Introduction: Thymectomy has always been considered an important treatment modality for patients with Myasthenia Gravis (MG). Because of the absence of randomized trials, its exact role was not clear and was even questioned by some. Indications for surgery were made on empirical basis. It was not until the results of the first randomized double- blinded multicentric study were published, where the combined surgical treatment of patients with nonthymomatous MG was proved superior to conservative treatment alone. In this study the technique of extensive thymectomy via longitudinal sternotomy was used as a mainstay of surgical treatment. In the advent of minimally invasive techniques a variety of options were presented for minimally invasive surgical treatment of thymic pathology. Methods: The authors present a retrospective analysis of short term results using the slightly modified method of “Minimally Invasive Maximal Thymectomy” developed by Zielinski over a 10 year period (2008−2018). Besides the demographics, we assessed the peri- and postoperative results such as the length of surgery, blood loss, the need for conversion, learning curve impact, the lengths of drainage and hospital stay and the complication rate, both surgical and systemic. Results: 48 patients underwent surgery using the above mentioned method for non-thymomatous MG. 81.25% (n=39) of patients were diagnosed with a seropositive generalized form of MG, 6 (12.5%) had seropositive ocular form and 3 patients (6.25%) had seronegative form of the disease. The sex ratio profoundly favored females (89.5%; n=43). The median value of the length of surgery was 186,5 minutes, the mean LOS and length of drainage were 4 and 3 days, respectively. Conclusion: According to our results and experience with Minimally Invasive Maximal Thymectomy, we found it to be an effective and safe method for MG patients after conquering the learning curve.

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Are two better than one? VALIFT: video-assisted ligation of the intersphincteric fistula tract—a combination of two minimally invasive techniques for treatment of transsphincteric perianal fistulas

Techniques in Coloproctology ◽

10.1007/s10151-019-1925-3 ◽

2019 ◽

Vol 23 (3) ◽

pp. 273-276 ◽

Cited By ~ 4

Author(s):

Michal Romaniszyn ◽

Piotr Julian Walega

Keyword(s):

Minimally Invasive ◽

Fistula Tract ◽

Minimally Invasive Techniques ◽

Perianal Fistulas ◽

Video Assisted ◽

Intersphincteric Fistula ◽

Invasive Techniques ◽

Better Than

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Considerations in Dysphagia Management Following Esophagectomy

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.169 ◽

2016 ◽

Vol 1 (13) ◽

pp. 169-176

Author(s):

Lisa M. Evangelista ◽

James L. Coyle

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Surgical Procedures ◽

Esophageal Resection ◽

Minimally Invasive Surgical ◽

Operative Complications ◽

Swallowing Difficulties ◽

Epidemiological Impact ◽

Invasive Techniques ◽

Management Of Dysphagia

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Esophageal resection is the mainstay treatment for cancers of the esophagus. While curative, surgical resection may result in swallowing difficulties that require intervention from speech-language pathologists (SLPs). Minimally invasive surgical procedures for esophageal resection have aimed to reduce morbidity and mortality associated with more invasive techniques. Both intra-operative and post-operative complications, regardless of the surgical approach, can result in dysphagia. This article will review the epidemiological impact of esophageal cancers, operative complications resulting in dysphagia, and clinical assessment and management of dysphagia pertinent to esophageal resection.

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