Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Kneuertz, Peter J.; Kamel, Mohamed; Stiles, Brendon M.; Lee, Benjamin E.; Rahouma, Mohamed; Nasar, Abu; Altorki, Nasser K.; Port, Jeffrey L.

doi:10.1016/j.athoracsur.2017.05.074

Cited by 53 publications

(59 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As shown in previous publications, resection of large thymic tumors by robotic surgery is safe and effective. (12,23) In our study, large tumors (largest diameter: 12.5 cm) were resected, which corroborates the hypothesis that size should not be considered an absolute contraindication to the method. Currently, the major limitation in cases of mediastinal lesions is the invasion of vascular structures, because the use of robots has not been proven safe in those cases.…”

Section: Discussionsupporting

confidence: 87%

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

et al. 2020

View full text Add to dashboard Cite

Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.

show abstract

Section: Discussionsupporting

confidence: 87%

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Several of the studies had a high risk of selection bias due to historical controls (24,32,34,36,37), differences in criteria for patient selection (22,33), or patient characteristic differences between groups (23). Studies that performed propensity score matching for outcomes of interest were considered at low risk for selection bias (25,(27)(28)(29)(30)35), as were the papers by Qian et al (31) and Ye et al (39), due to contemporary controls, the same selection criteria, and no differences in patient characteristics. Most of the studies were rated as unknown or high risk for performance bias due to a lack of information provided on surgical techniques and care pathways.…”

Section: Quality Of Evidence: Risk Of Biasmentioning

confidence: 99%

“…The paper by Weksler et al (36) was assessed as having a high risk of detection bias because the authors specifically mentioned not being able to obtain accurate operative times for the transsternal group and did not report all of the same outcomes for each group. All of the other studies were rated as unclear risk due to a lack of information (22,24,26,28,35,39), or as low risk of detection bias due to prospectively collected data (27,33,34,37), data entry into a registry (23), precise definitions of outcomes provided (25,29,30,38), or because any missing definitions were unlikely to affect outcomes (31,32). The study by Weksler et al (36) was also assessed as high risk for attrition bias because of incomplete data that was likely due to intervention type.…”

Section: Quality Of Evidence: Risk Of Biasmentioning

confidence: 99%

“…Of those, 12 reported data in sufficient detail for metaanalysis (22,24,25,(27)(28)(29)(30)(31)(32)35,37,38), which showed equivalent operative time for robotic thymectomy vs. open surgery (WMD: 6.73; 95% CI: −21.20, 34.66, P=0.64) with significant heterogeneity (P<0.00001, I 2 =97%), perhaps due to differences in definitions of operative time between studies. Eight studies reported on intraoperative blood loss (EBL) (27)(28)(29)31,32,36,37,39), of these, seven reported EBL in enough detail for pooled analysis ( Figure 3B) (27)(28)(29)31,36,37,39), which showed significantly lower blood loss in the robotic group (WMD: −173.03; 95% CI: −305.90, −40.17, P=0.01), but with significant heterogeneity (P<0.00001, I 2 =99%) due to large variance in the magnitude of the robotic benefit; all seven papers reported significantly lower EBL for the robotic group. Only one study reported on blood transfusions (R 0% vs. O 0%, ns) (38).…”

Section: Quality Of Evidence: Risk Of Biasmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy

O’Sullivan¹,

Kreaden²,

Slee³

et al. 2019

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Median sternotomy has been the most commonly used approach for thymectomy to date. Recent advances in video-assisted thoracoscopic surgery (VATS) and robotic access with CO 2 insufflation techniques have allowed more minimally invasive approaches. However, prior reviews have not compared robotic to both open and VATS thymectomy. Methods: A systematic review was conducted in accordance with the PRISMA guidelines using PubMed, Embase and Scopus databases. Original research articles comparing robotic to VATS or to open thymectomy for myasthenia gravis, anterior mediastinal masses, or thymomas were included. Meta-analyses were performed for mortality, operative time, blood loss, transfusions, length of stay, conversion to open, intraoperative and postoperative complication rates, and positive/negative margin rates.

show abstract

“…Furthermore, robotic thymectomy might be considered a safe and effective procedure for thymomas, also in large tumours with equivalent radicality when compared to open procedures yet with lower morbidity and shorter hospital stay (5)(6)(7).…”

mentioning

confidence: 99%

How to get the best from robotic thoracic surgery

et al. 2018

View full text Add to dashboard Cite

The application of Robotic technology in thoracic surgery has become widespread in the last decades. Thanks to its advanced features, the robotic system allows to perform a broad range of complex operations safely and in a comfortable way, with valuable advantages related to low invasiveness. Regarding lung tumours, several studies have shown the benefits of robotic surgery including lower blood loss and improved lymph node removal when compared with other minimally invasive techniques. Moreover, the robotic instruments allow to reach deep and narrow spaces permitting safe and precise removal of tumours located in remote areas, such as retrosternal and posterior mediastinal spaces with outstanding postoperative and oncological results. One controversial finding about the application of robotic system is its high capital and running costs. For this reason, a limited number of centres worldwide are able to employ this groundbreaking technology and there are limited possibilities for the trainees to acquire the necessary skills in robotic surgery. Therefore, a training programme based on three steps of learning, associated with a solid surgical background and a consistent operating activity, are required to obtain effective results. Putting this highest technological innovation in the hand of expert surgeons we can assure safe and effective procedures getting the best from robotic thoracic surgery.

show abstract

Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Abstract: RAT can be performed safely and effectively in a radical fashion for large thymomas. Future studies are necessary to determine long-term oncologic outcomes.

Cited by 53 publications

References 19 publications

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy

How to get the best from robotic thoracic surgery

Contact Info

Product

Resources

About