Experience With the “Da Vinci” Robotic System for Thymectomy in Patients With Myasthenia Gravis: Report of 33 Cases

Rea, Federico; Marulli, Giuseppe; Bortolotti, Luigi; Feltracco, Paolo; Zuin, Andrea; Sartori, F

doi:10.1016/j.athoracsur.2005.08.030

Cited by 135 publications

(88 citation statements)

References 20 publications

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“…It has been reported that for the treatment of stage I and II thymomas, there were no significant differences in the 5-year survival, 5-year recurrence-free survival (19), or mean survival time (4) between the VATS group and open surgery group. In addition, robots have more technical advantages with three-dimensional vision systems and multi-articulated instruments, which allows an open-like intervention, while robotic extended thymectomy has been shown to be feasible and safe (22,23). In a recent comparative study, no early recurrences were observed during the postoperative follow-up period of 17.5 months (range, 6-48 months) in the RATS group and 25.2 months (range, 6-48 months) in the VATS group (16).…”

Section: Discussionmentioning

confidence: 99%

A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy

et al. 2017

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Background: This aim of this study was to compare three approaches of extended thymectomy for the treatment of early-stage thymomas, which included robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and median sternotomy (MS) perioperative parameters. Results: A series of intra-and post-operative parameters showed significant differences in intra-operative blood loss volume, mean post-operative pleural drainage duration, pleural drainage volume and mean duration of hospital stay. For these parameters, during further analysis, significant differences were also demonstrated for comparisons between any two groups. RATS reduces the post-operative drainage duration and volume (2.88 vs. 3.77 and 4.41 days, P<0.05; 352.2 vs. 613.9 and 980 mL, P<0.05) and the hospital stay versus the MS and VATS groups (4.3 vs. 5.5 and 6.6 days). Three patients experienced post-operative complications in the MS group, and no post-operative complications occurred in the RATS or VATS group.Conclusions: RATS and VATS both appear feasible and safe for the resection of early-stage thymomas as compared to MS. RATS is less invasive than VATS with a shorter post-operative pleural drainage duration time, a reduced drainage volume, and a shorter hospital stay.

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Section: Discussionmentioning

confidence: 99%

A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy

et al. 2017

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“…The first 5 mm trocar located in the sixth intercostal space between the anterior axillary and the mid-axillary line, and was introduced with the imaging system. Then, CO 2 insufflation started with pressure ranging from 6 to 10 mmHg (21). Under direct vision by endoscopic imaging system, the second and third trocars were introduced in the third and fifth (or sixth) intercostal space, about a handbreadth left or right of the camera trocar, as described in our previous Chinese publication (22).…”

Section: Surgical Techniquementioning

confidence: 99%

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

Yin

Huang²,

Han

et al. 2018

J. Thorac. Dis.

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Background: Robotic thymectomy has been suggested a feasible and safe approach for myasthenia gravis (MG). Few investigations have revealed the independent effect of robotic thymectomy without the confounding impact of immunosuppressive (IM) therapy. Results: Data of 37 cases was available for analysis. The mean follow-up was 70.0±13.3 months. The median age was 40 years. Twelve (32.4%) patients kept free of IM therapy, and 25 (67.6%) patients accepted postoperatively. The overall 5-year complete stable remission (CSR) rate was 40.6% and improvement rate was 81.6%. The young (age ≤40) displayed a significant better CSR rate (P=0.015) and a trend of better improvement rate (P=0.050) compared to the old (age >40). Patients without usage of IM therapy showed significant higher CSR rate (P=0.014) and improvement rate (P=0.024) compared to those with usage of IM therapy. Patients with Myasthenia Gravis Foundation of America (MGFA) classes I showed a trend of higher remission rate by multivariate analysis. No significant differences were found for the remission rate according to gender, pathology, and the duration of symptoms. Conclusions:The mono-therapy of robotic thymectomy may bring with a satisfactory long-term result for part of MG patients. Precision selection and individualized therapy are of the most importance. J Thorac Dis 2018;10(1):321-329 jtd.amegroups.com improvement clinical outcomes by thymectomy for patients with nonthymomatous MG. It was a great stride for surgical treatment of MG, but there still remains several questions with regards to the candidates, the optimal surgical approach, the timing and the extent of resection (4,5).Representing the newest minimal invasive technique, robotic thymectomy has been increasing rapidly worldwide in recent years, as it provides with multiple advantages with less trauma comparing to the open procedure (6-8). The long-term results of robotic thymectomy for MG have also been published by several investigators (9-11). Whereas, immunotherapy as the mainstay of treatment for MG, it is frequently given to thymectomized patients to maintain pharmacologic remission (PR) nowadays (12-15). The usage of immunosuppressants would certainly play a role in the overall remission rate of thymectomized MG patients (16). However, few investigations of robotic thymectomy for MG has separated the confounding influence of immunotherapy when analyze the long-term results. Thus, the actual independent effect of robotic thymectomy for MG patients is unclear.The present report introduces our observation of the relatively independent long-term results after robotic thymectomy for MG. MethodsA retrospectively study was performed for patients who diagnosed as MG and underwent robotic extended thymectomy with da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, CA, USA) in department of thoracic surgery of PLA Rocket Force General Hospital between May 2009 and December 2012. The study was approved by the medical ethics committee of PLA Rocket Force General Hospital (approval number ...

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“…In addition, since in the first decades of the twentieth century was observed an improvement of myasthenia gravis (MG) after thymectomy, this procedure has gained importance in the multidisciplinary treatment of MG, becoming a widely accepted therapeutic option (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

Robotic thymectomy

Marulli¹,

Comacchio²,

Rea³

2017

J. Vis. Surg.

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Thymectomy is the most frequent surgical operation involving the mediastinum, both for the treatment of thymic tumors and for the multidisciplinary management of myasthenia gravis (MG). Different surgical approaches have been described, either traditional open approaches or minimally invasive ones.Robotic thymectomy represents a further step in the evolution of minimally invasive surgery. Available data show that robotic thymectomy may be considered a safe and feasible operation, with encouraging long-term results in myasthenic patients and promising results in patients with early stage thymoma, both in terms of surgical and oncological outcomes. We present the surgical technique of robotic thymectomy that we apply for patients affected by myasthenia gravis and early stage thymoma. that could be related to MG and to evaluate the serum titer of antibodies against acetylcholine-receptor. If negative, anti-MuSK (muscle specific receptor tyrosine kinase) antibodies should be tested; there is evidence that a positive serum titer of anti-MuSK Ab is predictive of a lesser effect of thymectomy on MG symptoms (14).Anyway, neurological assessment prior to surgery should be always performed to evaluate presence of active or significant symptoms of MG or to optimize the medical treatment. Particularly, the levels of corticosteroids should be decreased, prior to surgery. The risk of post-operative respiratory failure may be reduced by preoperative intravenous immunoglobulin administration or plasmapheresis, particularly in patients with partiallycontrolled symptoms (15,16).Regarding timing for surgery, there isn't a gold standard, but it seems that an early removal of the thymic gland may improve the remission rate (16). Age over 50 years or antibody-negative disease are relative contraindications to thymectomy in nonthymomatous MG (17,18).Moreover, all patients should be evaluated with a contrast-enhanced CT scan of the chest. Magnetic resonance and/or PET-CT scan can also be performed in the suspicion of thymoma or to distinguish between a thymic hyperplasia and a small thymoma.Pre-operative chest X-rays should be performed to evaluate signs of extensive adhesions, related to prior pleuritis or thoracic surgical procedure, which may preclude a robotic approach.Functional assessment should be completed with pulmonary function tests, complete blood examination and electrocardiogram. Pre-operative preparationThe operation is performed under general anesthesia and the patient is ventilated through a double-lumen endotracheal tube. During procedure, patients are monitored by ECG, arterial line, pulse oximeter and urine output.The patient is placed left or right-side up (based the side of operation), at a 30-degree angle with a bean bag. In leftsided approaches, the left arm is placed parallel to the bed while the right arm is positioned along the body to expose the axillary region (opposite for right-side operations). In the operating room the surgeon console is positioned away from the patient while the video column ...

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Experience With the “Da Vinci” Robotic System for Thymectomy in Patients With Myasthenia Gravis: Report of 33 Cases

Cited by 135 publications

References 20 publications

A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy

A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

Robotic thymectomy

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