Videothoracoscopic Approach to Primary Mediastinal Pathology

Roviaro, Giancarlo; Varoli, F.; Nucca, O.; Vergani, Contardo; Maciocco, M.

doi:10.1378/chest.117.4.1179

Cited by 85 publications

(49 citation statements)

References 12 publications

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“…The controversies surrounding minimally invasive surgeries mainly focus on the oncological concerns (possible breach of tumor capsule, risk of tumor seeding) (21). 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.…”

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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“…Nitekim 2000 yılın-da yayınlanan bir seride timoma rezeksiyonu sonrası torakoskopi insizyonunda lokal ve plevra rekürensi bildirilmiştir (2). Nadir vaka takdimleri arasında VATS ile rezeke edilen timolipomda bulunmaktadır.…”

Section: öN Mediastinal Tümörlerunclassified

“…Mediastinal kitlelerde VATS teşhis, evreleme ve tedavi amaçlı uygulanmaktadır (2). Mediastinal kitleler değişik yaş gruplarında ve mediastenin farklı bölgele-rinde görülebilirler.…”

Section: Introductionunclassified

“…Ön mediastende en sık karşılaşılan lezyonlar timoma ve lenfoma iken, orta mediastende kistik lezyonlar (bronkojenik kist, perikardiyal kist) ve teratoma, arka mediastende ise mezenkimal tümörler ve nörojenik tümörler sık görülür. VATS başlangıçta sınırlı boyutlarda (<5 cm) özellikle nörojenik tümörlerin, bronkojenik kistlerin ve bazı plevra kaynaklı kitlelerin çıkarılması için kullanılmıştır (1)(2)(3). Mediastinal kitlelerde ilk VATS deneyimi teşhis amaçlı olmuş ve 1993'te yayınlanan 22 vakalık seride, ince iğne aspirasyon biyopsisi ile tanı konulamayan vakaların 19'unda VATS ile sonuç elde edilmiştir (1).…”

Section: Introductionunclassified

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Mediastinal Kitlelere Yaklasimda Vats

Batırel¹

2011

Toraks Cer Bult

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“…However, the choice of the specific minimally invasive technique of thymectomy is a specific unsolved problem. There are several operative approaches for minimally invasive thymectomy including unilateral video-assisted thoracic surgery (VATS), bilateral VATS, robotic videoassisted techniques (RATS), transcervical thymectomy and subxiphoid thymectomy (7)(8)(9)(10)(11)(12). This last approach was introduced by Kido et al, who performed thymectomy within the mediastinum, without opening of the mediastinal pleura (12).…”

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Subxiphoid uniportal VATS thymectomy

et al. 2017

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Background: To present the technique of minimally invasive extended thymectomy performed through the uniportal subxiphoid approach, with double elevation of the sternum for nonthymomatous myasthenia gravis (MG). Methods:Operative technique: the whole dissection was performed through the 4-7 cm transverse or longitudinal subxiphoid incision with use of videothoracoscope. The sternum was elevated with two hooks connected to the sternal frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland). The lower hook was inserted through the subxiphoid incision and the superior hook was inserted percutaneously, after the mediastinal tissue including the major mediastinal vessels were dissected from the inner surface of the sternum.The fatty tissue of the anterior mediastinum and the aorta-pulmonary window was completely removed.Results: There were four patients in the period 1.1.2017-30.4.2017. There was no mortality and morbidity. Conclusions:The uniportal subxiphoid approach combined with double elevation of the sternum enabled very extensive thymectomy in case of thymoma. However, the choice of the specific minimally invasive technique of thymectomy is a specific unsolved problem. There are several operative approaches for minimally invasive thymectomy including unilateral video-assisted thoracic surgery (VATS), bilateral VATS, robotic videoassisted techniques (RATS), transcervical thymectomy and subxiphoid thymectomy (7)(8)(9)(10)(11)(12). This last approach was introduced by Kido et al., who performed thymectomy within the mediastinum, without opening of the mediastinal pleura (12). During the last decade the uniportal subxiphoid approach was used successfully. However, with exception of Suda et al. who described their experience in several publications in the other two studies only case reports were presented (13-15). Our team was the second one using the subxiphoid approach but out policy was quite different from the method of Kido et al. We used the technique combining the transcervical and subxiphoid incisions with double elevation of the sternum with use of the Rochard frame and bilateral single VATS ports and performed thymectomy in the maximally extended technique, similar to this described by Jaretzki et al. who use the transcervical-transsternal approach (2,16). Subsequently, we modified our technique by introduction of the subxiphoid-right VATS approach, the subxiphoid-bilateral VATS approach and, finally by the uniportal subxiphoid approach, which will be described in this article (17,18). Keywords Patients selection and work-upAll patients with nonthymomatous MG are the candidates for this kind of procedure. In case of the advanced stage III thymomas the transsternal approach is preferred. In case of nonthymomatous MG the operation is proposed primarily to patients in the MGFA class I-IIIb (mild to moderate ocular, bulbar and extremities muscles affected) (19). In case of severe MG the operation is postponed until the patient's clinical improvement after preoperative preparation with steroids, immunosuppres...

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Videothoracoscopic Approach to Primary Mediastinal Pathology

Cited by 85 publications

References 12 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

Mediastinal Kitlelere Yaklasimda Vats

Subxiphoid uniportal VATS thymectomy

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