<i>Thoracoscopic Thymectomy with the da Vinci Robotic System for Myasthenia Gravis</i>

Rückert, Jens C.; Ismail, Mahmoud; Swierzy, Marc; Sobel, H. K.; Rogalla, Patrik; Meisel, Andreas; Wernecke, Klaus D.; Rückert, Ralph I.; Müller, J. M.

doi:10.1196/annals.1405.013

Cited by 105 publications

(97 citation statements)

References 62 publications

(128 reference statements)

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“…23 Because the most common indications for thymectomies are MG and thymomas, surgeons must be assured that robotic-assisted thymectomies can yield the same clinical improvements as other types of thymectomies. Thus, many series have confirmed that robotic-assisted thymectomy is a plausible treatment option for patients with MG. [24][25][26][27][28][29][30] Hartwich et al 30 showed that robotic-assisted thymectomy can improve symptoms in children with MG. Collectively, 82% to 92% of patients had improved symptoms of MG following robotic-assisted thymectomy, and the complete remission rate was as high as 28.5%.…”

Section: Thymectomymentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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Section: Thymectomymentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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“…Finally, another disadvantage is represented by the placement of the surgeon, operating at a non-sterile console away from the patient (12,31). Thus, the sterile surgeon near the robot should be able to perform alone an emergency conversion.…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

“…Rea and Ashton both described in 2003 the first series of patients undergoing robotic thymectomy for MG, using the latter a right-sided approach with completion of the operation through the left side, while the former used only a left-side approach (8,9). In the following years, different authors described their results with robotic thymectomy both for thymic tumors and in cases of nonthymomatous myasthenia gravis (10)(11)(12). Analysis of literature data shows that robotic approach in thymectomy is a feasible and safe operation.…”

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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“…Over the past decade, minimally invasive surgery of the thymus has been developed, including a variety of access incisions, methods of exposure, visualisation and equipment [33,34]. This includes transcervical, extended transcervical, video-assisted thoracoscopy and robotic approaches (right or left, right and left, right and cervical, left and cervical, subxiphoid and right and left, cervical and subxiphoid).…”

Section: Surgery Principlesmentioning

confidence: 99%

Thymic epithelial tumours: from basic principles to individualised treatment strategies

Girard¹

2013

Eur Respir Rev

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Thymic epithelial tumours represent a wide range of anatomical, clinical, histological and molecular malignant entities that may be aggressive and difficult to treat. The histopathological classification distinguishes thymomas from thymic carcinomas. Thymomas may be associated with autoimmune disorders.The management of thymic epithelial tumours is a paradigm of co-operation between clinicians, surgeons and pathologists, from establishing the diagnosis to organising the multimodal therapeutic strategy. Surgery is the mainstay of the curative-intent treatment, as complete resection represents the most significantly favourable prognostic factor on overall survival. In case of invasion of intra-thoracic structures and/or dissemination to the pleura and the pericardium, precluding complete resection to be achieved, primary chemotherapy has been used to reduce the tumour burden, possibly allowing subsequent surgery and/or radiotherapy.Novel strategies are needed, especially for refractory, recurrent tumours and thymic carcinomas, which carry a poor prognosis. Personalised approaches are currently being developed, as potentially ''druggable'' molecular targets are emerging from recent integrated genomic analyses. Along with the large variety of questions relative to the treatment strategy, thymic epithelial tumours represent a model of therapeutic implementation and achievement in orphan thoracic oncology, showing how the advent of new results induces new questions, as well as diversifies further clinical research directions and international collaborative initiatives.

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Thoracoscopic Thymectomy with the da Vinci Robotic System for Myasthenia Gravis

Cited by 105 publications

References 62 publications

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Robotic thymectomy

Thymic epithelial tumours: from basic principles to individualised treatment strategies

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