Minimally Invasive versus Open Thymectomy for Thymic Malignancies: Systematic Review and Meta-Analysis

Friedant, Adam; Handorf, Elizabeth A.; Su, Stacey; Scott, Walter J.

doi:10.1016/j.jtho.2015.08.004

Cited by 140 publications

(102 citation statements)

References 41 publications

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“…Nevertheless, a recent meta-analysis of non-randomized case studies demonstrated no difference between open approaches and MIS with regard to complications, rate of R0 resection and recurrence rate (1). This meta-analysis showed an advantage of the MIS approach in terms of blood loss and length of stay, though (1).…”

Section: Introductionmentioning

confidence: 71%

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Terra

2017

J. Vis. Surg.

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Literature suggests that, for thymectomy in myasthenia or resection of thymic tumors, minimally invasive surgery is equivalent to open surgery with regard to long-term outcomes. However, it could bring some benefits in the immediate results as complication rate or length-of-stay. There are doubts about the worldwide adoption of the method, though. In Latin America, the implementation of video-assisted thoracic surgery (VATS) started in the 1990s, but it progressed slowly. The main barriers were associated costs and training. Thymic surgery poses a bigger challenge due to its rarity, so just a few reports mention the use of the method in the region. Nonetheless, in recent years we observe a faster dissemination of the method both in number and in complexity of the procedures performed. Confirming this fact, half of the patients registered in the Brazilian Society of Thoracic Surgery database in the last 2 years as undergoing resection of thymic tumors, underwent a minimally invasive procedure. Although promising, robotic surgery is still in its early days in Latin America.

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Section: Introductionmentioning

confidence: 71%

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Terra

2017

J. Vis. Surg.

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“…Incomplete thymectomy operations are unacceptable in patients with MG. This includes either the patient has a thymoma or not (11).…”

Section: Discussionmentioning

confidence: 99%

Robotic thymectomy—a new approach for thymus

et al. 2017

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Advancements in modern technology bring many evolutions in minimally invasive surgery such as robot assisted approaches. Because of complete resection is so important in thymectomy operations, they became a new era for robotic surgery as a result of its superiorities (intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision).

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“…Historically, clinicians have been averse to use minimally invasive techniques for thymic tumors, both because of the supposed risk of rupture of the tumors' capsule during the manipulation of the lesion with the endoscopic instruments and the possibility of reduced safety margins with an increased probability of local recurrence (25)(26)(27).…”

Section: Tips Tricks and Pitfallsmentioning

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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Minimally Invasive versus Open Thymectomy for Thymic Malignancies: Systematic Review and Meta-Analysis

Cited by 140 publications

References 41 publications

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Robotic thymectomy—a new approach for thymus

Robotic thymectomy

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