Subxiphoid Robot-Assisted Thymectomy With Vascular Prosthetic Replacement

Suda, Takashi; Nagano, Hiromitsu; Kawai, Hiroshi; Hoshikawa, Yasushi

doi:10.1053/j.semtcvs.2019.06.007

Cited by 6 publications

(6 citation statements)

References 2 publications

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“…Subxiphoid approach: this approach allows for a wide view of the mediastinum, very similar to the field of the sternotomy, especially of the upper thymic poles, the innominate vein and bilateral phrenic nerves. It has been shown to be feasible ( 11 ) and to have good early clinical outcomes ( 38 ). Depending on the extension of the lesion and the technical difficulty of the resection, it could be performed with three or four robotic arms.…”

Section: Current Literature Review and Discussionmentioning

confidence: 99%

The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review

2022

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Background and Objective Beyond diagnosis, minimally invasive surgery has traditionally not been considered suitable for large tumors, those invading vital structures or high-risk patients. However, with the improvement of multimodality treatments able to reduce tumor size preoperatively, patient evaluation and selection, perioperative care (including both surgical and anesthesiological techniques) and postoperative management, the indications of minimally invasive surgery, even in giant mediastinal tumors, have increased and will continue to broaden in future years. This review aims to summarize the existing literature regarding the role of minimally invasive surgery in the management of giant mediastinal tumors. We have focused in the role minimally invasive surgery has in diagnosis and treatment of these tumors and we have tried to provide an updated perspective to identify future applications and work-directions. Methods Data regarding minimally invasive surgery in giant mediastinal tumors are limited, including a proper definition of them. We performed a PubMed search of English and Spanish written studies until August 2021. Key Content and Findings There is limited data related to minimally invasive surgery in giant mediastinal tumors and much of the literature review we have performed has yielded isolated case reports, case series with a low number of cases or editorials. Although the role of minimally invasive surgery is well consolidated as a diagnostic approach, adequate patient selection, hospital volume and experience, multidisciplinary discussion of candidates, patient safety and adequate oncological resection remain the most important aspects to be taken into account when considering a minimally invasive approach for a giant mediastinal tumor. Conclusions With careful and multidisciplinary perioperative planning, minimally invasive surgery has shown to be safe and to provide at least similar outcomes when compared to open approaches in well selected cases. Although data is still limited, improved surgical techniques and available technology will pave the way to increased indications of minimally invasive surgery in giant mediastinal tumors.

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Section: Current Literature Review and Discussionmentioning

confidence: 99%

The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review

2022

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“…Bilateral VATS and sternotomy lead to major incisions and severe postoperative pain. Robotic-assisted surgery is also a potential choice with advantages of enhanced dexterity and greater precision ( 19 ), but further validation in retrosternal goiter resection is still needed.…”

Section: Discussionmentioning

confidence: 99%

Modified subxiphoid approach for surgical resection of a retrosternal goiter

Wang

Li²,

Jiang³

et al. 2022

Front. Surg.

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BackgroundsUnilateral Video-Assisted Thorascopic Surgery (VATS) is a traditional minimally invasive transthoracic approach for the surgical resection of a subxiphoid goiter. Recently, the subxiphoid approach was recommended for an anterior mediastinal mass. This study aims to investigate the feasibility and efficacy of a modified subxiphoid VATS for the resection of a retrosternal goiter as an alternative transthoracic approach.MethodsWe retrospectively collected all patients who underwent subxiphoid VATS for the resection of a retrosternal goiter from June 2017 to June 2021 in the Zhongshan Hospital or the Zhongshan Hospital Xiamen branch. Ten patients were found. Patient characteristics, perioperative data, and surgical information were collected and further analyzed.ResultsIn our study, all 10 patients underwent a thoracoscopic subxiphoid resection of a retrosternal goiter. The mean age was 49.4 years, and all were female. The majority of patients (70%) were asymptomatic. All patients were assessed by CT imaging before surgery. The mean postoperative hospital stay was 4.9 days. The drainage tube was removed 3 days after operation, and the average drainage volume was 73.1 ml. Postoperative pain was mild, with an average pain grade of 2.4 (measured on a scale from 0 to 10, with lower scores indicating less pain). There were no conversions or perioperative complications in these 10 patients.ConclusionsMost retrosternal goiters can be completely resected through the modified subxiphoid approach after an adequate preoperative evaluation and careful intraoperative management. This thoracoscopic subxiphoid approach is feasible and safe for retrosternal goiter resection.

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“…These advantages also enable reconstruction of vessels under thoracoscopic view. Suda et al reported robot-assisted thymectomy with vascular replacement, they described that the robotic arms with movable joints similar to those of humans without physiological tremor facilitates vascular prosthetic replacement through endto-end anastomosis [12].…”

Section: Discussionmentioning

confidence: 99%

Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report

et al. 2020

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Background Robot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection. Case presentation A 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion. Conclusions RATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.

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Subxiphoid Robot-Assisted Thymectomy With Vascular Prosthetic Replacement

Cited by 6 publications

References 2 publications

The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review

The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review

Modified subxiphoid approach for surgical resection of a retrosternal goiter

Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report

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