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Zhang L, Li M, Jiang F, Zhang Z, Zhang Q, Xu L. Subxiphoid versus lateral intercostal approaches thoracoscopic thymectomy for non-myasthenic early-stage thymoma: A propensity score -matched analysis. Int J Surg 2019; 67:13-17. [PMID: 30677529 DOI: 10.1016/j.ijsu.2019.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Thymectomy is increasingly being performed via minimally invasive approaches. The present study aimed to assess the safety and feasibility of the subxiphoid approach to video-assisted thoracic surgery (VATS) compared with the lateral intercostal approach VATS. METHODS Patients who underwent VATS thymectomy via subxiphoid and lateral intercostal approaches in our hospital between 2015 and 2018 were retrospectively analyzed. A series of perioperative outcomes, including clinical and surgical results, postoperative pain scores and cosmetic results, was compared in a propensity score matching analysis. RESULTS A total of 98 patients diagnosed with non-myasthenic early-stage thymoma underwent complete thymectomy by VATS. Propensity score analysis revealed that 28 patients treated with the subxiphoid approach and 28 patients treated with the lateral intercostal approach had the same baseline characteristics. Compared with those in the lateral intercostal approach group, patients in the subxiphoidapproach group yielded lower pain scores and shorter postoperative hospital stays. Other advantages of the subxiphoid approach included decreased inflammatory cytokine response and superior cosmesis. There were no significant differences in postoperative complications between the two groups. All these patients recovered well when discharged. There were no perioperative deaths. CONCLUSIONS Our data suggest that subxiphoid and subcostal arch thoracoscopic radical thymectomy is a less invasive procedure for the treatment of non-myasthenic early-stage thymoma and provides a satisfactory cosmetic effect. Owing to the limitation ofour retrospective study, further prospective studies are needed to evaluate long-term and oncologic outcomes of subxiphoid approach VATS thymectomy.
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Affiliation(s)
- Louqian Zhang
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Ming Li
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Feng Jiang
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Zhi Zhang
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Qin Zhang
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China.
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Migliore M, Criscione A, Nardini M, Patti F, Borrata F. Single incision extended video assisted transcervical thymectomy. J Vis Surg 2017; 3:154. [PMID: 29302430 PMCID: PMC5676154 DOI: 10.21037/jovs.2017.10.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Department of General and Medical Specialties, University of Catania, Policlinico University Hospital of Catania, Catania, Italy
| | - Alessandra Criscione
- Thoracic Surgery, Department of General and Medical Specialties, University of Catania, Policlinico University Hospital of Catania, Catania, Italy
| | - Marco Nardini
- Thoracic Surgery, Department of General and Medical Specialties, University of Catania, Policlinico University Hospital of Catania, Catania, Italy
| | - Francesco Patti
- Neurology Department, Policlinico University Hospital of Catania, Catania, Italy
| | - Francesco Borrata
- Thoracic Surgery, Department of General and Medical Specialties, University of Catania, Policlinico University Hospital of Catania, Catania, Italy
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First-in-Man Transcervical Surgical Aortic Valve Replacement Using the CoreVista System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:84-93. [PMID: 26889881 DOI: 10.1097/imi.0000000000000228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate a novel device system for surgical aortic valve replacement (SAVR) using a unique new less invasive access approach. The hypothesis is that SAVR can be performed through a short transverse incision in the neck, similar to that used for transcervical thymectomy avoiding chest disruption. METHODS A new device system was developed to provide retraction, step-by-step illumination, and on-screen visualization for the new approach. Preliminary feasibility studies were performed in cadavers. Comprehensive risk analysis was performed, and training was implemented in Thiel preserved cadavers. For the first-in-man clinical case, a 63-year-old woman with symptomatic critical aortic stenosis (The Society of Thoracic Surgeons risk, 11%) and heavily calcified aortic valve was selected. A short transverse incision was made in the neck; the device was introduced, and the sternum was elevated; femorofemoral cardiopulmonary bypass was established; substernal dissection was guided by the sequenced illumination, and high-definition visualization was provided by the device, allowing for optimal exposition of the aorta and aortic valve; and a 23-mm Medtronic ENABLE sutureless valve prosthesis was implanted. Procedure success was evaluated according to the standardized composite end point definition of "device success" proposed by the Valve Academic Research Consortium. RESULTS Access, delivery, and deployment of the valve prosthesis were successful. The correct position and intended performance of the valve were demonstrated (mean gradient, 6 mm Hg; aortic valve area, 2.5 cm) with the absence of moderate or severe prosthetic aortic regurgitation. Only one valve prosthesis was used. CONCLUSIONS Transcervical SAVR with sutureless valve is feasible using this novel access system. The new approach has potential to offer patients substantially shorter stay and fewer, less serious complications, as has been observed in transcervical thymectomy. Further studies are merited.
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Marulli G, Comacchio GM, Stocca F, Zampieri D, Romanello P, Calabrese F, Rebusso A, Rea F. Robotic-assisted thymectomy: current perspectives. ACTA ACUST UNITED AC 2016; 3:53-63. [PMID: 30697556 PMCID: PMC6193423 DOI: 10.2147/rsrr.s93012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Thymectomy is the cornerstone in the treatment of thymic tumors and an accepted option for the management of myasthenia gravis. Different surgical approaches have been described, but the gold standard is represented by median sternotomy. In the last two decades, the development of minimally invasive surgery has led to an increased acceptance of thymectomy, especially for benign diseases. Robotic thymectomy seems a further step in the development and evolution of minimally invasive approaches. Since its introduction, different authors described their experience with robotic thymectomy, both for nonthymomatous myasthenia gravis and for thymic tumors. Available data show that robotic thymectomy may be considered a safe and feasible operation. In patients with nonthymomatous myasthenia, robotic thymectomy is effective and the long-term results are encouraging. The role of robotic thymectomy in patients affected by thymoma is still under evaluation, but the intermediate results seem promising both in terms of surgical and oncologic outcomes.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Giovanni M Comacchio
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Stocca
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Davide Zampieri
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Paola Romanello
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Calabrese
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Alessandro Rebusso
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Federico Rea
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
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Dapunt OE, Luha O, Ebner A, Sonecki P, Spadaccio C, Sutherland FWH. First-in-Man Transcervical Surgical Aortic Valve Replacement Using the CoreVista System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Olev Luha
- Medical University of Graz, Graz, Austria
| | - Adrian Ebner
- Universidad Nacional de Asuncion Medicina, Paraguay, San Lorenzo, Paraguay
| | - Piotr Sonecki
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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Renaud S, Santelmo N, Renaud M, Falcoz P, Tranchant C, Massard G. Prise en charge chirurgicale de la myasthénie auto-immune (ou myasthenia gravis). ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1241-8226(12)59757-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tomulescu V, Popescu I. Unilateral extended thoracoscopic thymectomy for nontumoral myasthenia gravis--a new standard. Semin Thorac Cardiovasc Surg 2013; 24:115-22. [PMID: 22920527 DOI: 10.1053/j.semtcvs.2012.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2012] [Indexed: 11/11/2022]
Abstract
Myasthenia gravis (MG) is a heterogeneous disorder with a fluctuating, clinical, pathologic, and immunobiological picture. Today, it is believed that effective treatment of MG must include both immunosuppression and surgery. Thymectomy is recommended by neurologists for patients with nontumoral MG as an option to increase the probability of remission or improvement. Currently, thoracoscopic thymectomy is considered a good alternative to the standard open approach because of its higher rate of acceptance, low morbidity, and high efficacy, as measured by complete stable remission rates. We present a review of the experience of unilateral extended thoracoscopic thymectomy for nontumoral MG, a technique that could became a new standard in the complex management of MG treatment.
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Affiliation(s)
- Victor Tomulescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Sonett JR, Jaretzki III A. Thymectomy for NonthymomatousMyasthenia Gravis. Ann N Y Acad Sci 2008; 1132:315-28. [DOI: 10.1196/annals.1405.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shigemura N, Shiono H, Inoue M, Minami M, Ohta M, Okumura M, Matsuda H. Inclusion of the transcervical approach in video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis: a prospective trial. Surg Endosc 2006; 20:1614-8. [PMID: 16794781 DOI: 10.1007/s00464-005-0614-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Because evidence-based data regarding the quality of video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis are lacking, a prospective trial comparing three different operative approaches was conducted to evaluate their efficacy. METHODS This prospective study enrolled 20 consecutive patients with nonthymomatous myasthenia gravis. A series of three approaches for bilateral video-assisted thoracoscopic extended thymectomy (VATET) using the anterior chest wall-lifting method (original), the original method with a flexed-neck position (modified), and the original method with a transcervical approach (final) were prospectively performed in each patient for quantitative and pathologic evaluation of the residual thymus after each approach. RESULTS Complete VATET required 242 +/- 48 min, with the transcervical procedure requiring 23 +/- 12 min. After the modified method, the residual thymus in the cervical region was 1.5 cm in size and weighed 0.8 g (0.8% of the entire thymus), as compared with a size of 2.2 cm and a weight of 1.3 g (3.2%) after the original method. Each value is the result of comparison with the final method. Histopathologic studies showed residual tissue in the germinal center as well as Hassall's corpuscles in more than 70% of cases. CONCLUSION The findings show that VATET without the transcervical approach could be an immunologically incomplete treatment for myasthenia gravis. Therefore, the transcervical approach should be included in VATET procedures to ensure radicality.
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Affiliation(s)
- N Shigemura
- Department of Surgery, Osaka University Graduate School of Medicine, E1, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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