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Gibson EA, Brust K, Steffey MA. Evaluation of mediastinoscopy for cranial mediastinal and tracheobronchial lymphadenectomy in canine cadavers. Vet Surg 2024; 53:834-843. [PMID: 38686899 DOI: 10.1111/vsu.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN Cadaveric study. ANIMALS Large breed (25-40 kg) cadaver dogs (n = 10). METHODS Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
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Affiliation(s)
- Erin A Gibson
- William R. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Kelsey Brust
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Lin J, Lin N, Li X, Lai F. Transareolar uniportal thoracoscopic extended thymectomy for patients with myasthenia gravis. Front Surg 2022; 9:914677. [PMID: 36303858 PMCID: PMC9592845 DOI: 10.3389/fsurg.2022.914677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Transareolar uniportal thoracoscopic extended thymectomy (TUTET) has not been previously reported. We attempted to assess the feasibility and safety of TUTET for male myasthenia gravis (MG) patients. Patients and methods From February 2013 to February 2020, 46 men with MG underwent TUTET. All patients were followed up for 12–84 months postoperatively by clinic visits or telephone/e-mail interviews. Results All surgeries were completed successfully, with an average operation time of 72.6 min. The mean length of transareolar uniportal incision was 3.0 ± 0.4 cm, and the mean postoperative cosmetic score was 3.1 ± 0.5 at discharge. Three months postoperatively, no patients had an apparent surgical scar on the chest wall or complained of postoperative pain. Substantial amelioration of the disease was achieved in a short period, and several benefits were clear. At the 1-year follow-up, all patients showed a good cosmetic effect and high satisfaction. Conclusions TUTET is an effective and safe way for men with MG. The uniportal incision is hidden in the areola with sound cosmetic effects. We believe that TUTET is an acceptable procedure for extended thymectomy.
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Affiliation(s)
- Jianbo Lin
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China,Correspondence: Jianbo Lin Fancai Lai
| | - Nanlong Lin
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xu Li
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China,Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fancai Lai
- Department of Thoracic Surgery, Palmar Hyperhidrosis Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China,Correspondence: Jianbo Lin Fancai Lai
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Kang DK, Kang MK. Subxiphoid single-port thymectomy without CO 2 insufflation: Experience of a single center. Asian Cardiovasc Thorac Ann 2022; 30:706-710. [PMID: 35616921 DOI: 10.1177/02184923221104676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The subxiphoid single-port approach for thymectomy has advantages compared with conventional lateral transthoracic approaches. Most of centers use CO2 insufflation to secure an appropriate surgical field during subxiphoid thymectomy, which causes fighting between surgical instruments and restrictions on the types of surgical instruments. The objective of this study is to introduce an effective method to establish the subxiphoid approach without CO2 insufflation using a retractor and steel wire. METHODS All consecutive 59 patients undergoing subxiphoid single-port thymectomy between August 2014 and August 2021 were reviewed retrospectively. RESULTS We analyzed data of 59 patients (31 male and 28 female) with a median age of 59 years (range 50-68). Two (3.4%) patients presented postoperative complications. The conversion to a different approach was required in 4 (6.8%) cases. The median follow-up time was 23 months (range 10-41) and loco-regional recurrence was observed in one patient (1.7%). There were no intraoperative deaths and the postoperative mortality. No complications related to sternal wiring occurred. CONCLUSIONS Subxiphoid single-port thymectomy without CO2 using a retractor and steel wire insufflation is a technically feasible method.
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Affiliation(s)
- Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, 222187Inje University College of Medicine, Busan, Korea
| | - Min Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, 222187Inje University College of Medicine, Busan, Korea
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Menghesha H, Schroeter M, Doerr F, Schlachtenberger G, Heldwein MB, Chiapponi C, Wahlers T, Bruns C, Hekmat K. [The value of thymectomy in the treatment of non-thymomatous myasthenia gravis]. Chirurg 2021; 93:48-55. [PMID: 34132824 PMCID: PMC8766382 DOI: 10.1007/s00104-021-01436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
The value of thymectomy in the treatment of non-thymomatous myasthenia gravis has been controversially discussed. The relatively low incidence and prevalence of this disease, the inconsistent documentation in various studies and the necessity of a long-term follow-up to assess the therapeutic effects has made the generation of valid data difficult. The publication in 2016 of the MGTX trial in the New England Journal of Medicine delivered the first randomized controlled data in which patients aged 18-65 years with generalized myasthenia gravis and positive for acetylcholine receptor antibodies showed a significant benefit after surgical resection of the thymus via median sternotomy. Despite a lack of validation of the advantages of thymectomy by minimally invasive surgery from randomized controlled studies, this technique seems to positively influence the outcome of certain patient groups in a similar way. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) using subxyphoidal and transcervical access routes showed not only esthetic advantages but also showed no relevant inferiority in the influence on clinical outcomes of myasthenia gravis compared to median sternotomy; however, not only the benefits and the esthetic results show differences but also the advantages in the various subtypes of myasthenia gravis show divergent prospects of success with respect to remission. The clinical spectrum of myasthenia is heterogeneous with respect to the occurrence of antibodies, the body region affected and the age of the patient at first diagnosis. Ultimately, thymectomy is an effective causal treatment of myasthenia gravis.
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Affiliation(s)
- Hruy Menghesha
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland.
| | - Michael Schroeter
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Fabian Doerr
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
| | - Georg Schlachtenberger
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
| | - Matthias B Heldwein
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
| | - Costanza Chiapponi
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor-, und Transplantationschirurgie, Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Thorsten Wahlers
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
| | - Christiane Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor-, und Transplantationschirurgie, Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Khosro Hekmat
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinik Köln, Universität zu Köln, Kerpener Straße 62, 50931, Köln, Deutschland
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Alqarni F, Almalki D, Aljohani Z, Ali A, AlSaleem A, Alotaibi N, Odeh S, Dalbhi SA. Prevalence and risk factors of myasthenia gravis recurrence post-thymectomy. ACTA ACUST UNITED AC 2021; 26:4-14. [PMID: 33530037 PMCID: PMC8015504 DOI: 10.17712/nsj.2021.1.20190041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/30/2020] [Indexed: 12/13/2022]
Abstract
Objectives: To evaluate the prevalence and the factors associated with recurrence of myasthenia gravis following thymectomy. Methods: Six electronic databases which reported on recurrence of myasthenia gravis following thymectomy and/or its risk factors from 1985 to 2018 were searched. Summary prevalence and risk values obtained based on the random effect models were reported. Results: Seventy (70) papers containing 7,287 individuals with myasthenia gravis who received thymectomy as part of their management were retrieved. The patients had a mean follow-up of 4.65 years post-thymectomy. The prevalence of myasthenia gravis recurrence post-thymectomy was 18.0% (95% CI 14.7–22.0%; 1865/7287). Evident heterogeneity was observed (I2=93.6%; p<0.001). Recurrence rate was insignificantly higher in male compared with female patients (31.3 vs. 23.8%; p=0.104). Pooled recurrence rates for thymomatous (33.3%) was higher than the rate among non-thymomatous (20.8%) myasthenia gravis patients (Q=4.19, p=0.041). Risk factors for recurrence include older age, male sex, disease severity, having thymomatous myasthenia gravis, longer duration of the myasthenia gravis before surgery, and having an ectopic thymic tissue. Conclusion: A fifth of individuals with myasthenia gravis experience recurrence after thymectomy. Closer monitoring should be given to at-risk patients and further studies are needed to understand interventions to address these risks.
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Affiliation(s)
- Fatmah Alqarni
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Daifallah Almalki
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ziyad Aljohani
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Abdulrahman Ali
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Alanood AlSaleem
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Noura Alotaibi
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Shahla Odeh
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Sultan Al Dalbhi
- From the Department of Medicine (Alqarni, AlSaleem, Odeh), Princess Nourah Bin Abdulrahman University, Department of Neurology (Ali), King Fahad Medical City, Riyadh, College of Nursing (Alotaibi), King Saud Bin Abdulaziz University for Health Sciences, Department of Nephrology (Al Dalbhi), Prince Sultan Military Medical City, Riyadh, Department of Internal Medicine (Almalki), Prince Sattam Bin Abdulaziz University, Al-Kharj, Department of Neurology (Aljohani), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
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Abu-Akar F, Gonzalez-Rivas D, Yang C, Lin L, Wu L, Jiang L. Subxiphoid Uniportal VATS for Thymic and Combined Mediastinal and Pulmonary Resections – A Two-Year Experience. Semin Thorac Cardiovasc Surg 2019; 31:614-619. [DOI: 10.1053/j.semtcvs.2019.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
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Okumura M, Shintani Y, Ohta M, Kadota Y, Inoue M, Shiono H. Minimally invasive surgical procedures for thymic disease in Asia. J Vis Surg 2017; 3:96. [PMID: 29078658 DOI: 10.21037/jovs.2017.06.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/22/2017] [Indexed: 12/25/2022]
Abstract
Video-assisted thoracic surgery (VATS) procedures for thymic tumors and myasthenia gravis were introduced in Asia in the middle 1990s in at least two regions, Hong Kong and Japan. To overcome difficulties in obtaining a wide view of the anterior mediastinum, several methods for lifting the sternum or anterior chest wall have been presented, mainly by Japanese surgeons. More recently, single port VATS through a subxiphoid incision was also introduced in Japan. The long-term outcome of a VATS extended thymectomy for myasthenia gravis has been shown to be comparable to that of a trans-sternal extended thymectomy, while the long-term outcome of a VATS thymectomy for thymic epithelial tumors remains to be elucidated. Nevertheless, its indication for tumors in an early stage is now widely accepted, and the number of VATS procedures is steadily increasing in Japan and China. Single-port VATS through a subxiphoid incision was developed in Japan and might become accepted as a useful approach in the near future when combined with robot-assisted thoracoscopic surgery. In addition, robot-assisted thoracoscopic surgery for the thymus has also been introduced in some areas in Asia. Although few of those surgical procedures for the thymus have been performed, results obtained thus far indicate that it might be preferable to lung resection. Several novel minimally invasive thymectomy techniques have been invented and developed in Asia, and further advancements in this field by Asian surgeons are anticipated.
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Affiliation(s)
- Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsunori Ohta
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Yoshihisa Kadota
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyuki Shiono
- Department of Thoracic Surgery, Kindai University Nara Hospital, Nara, Japan
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Shiono H, Sakamoto T, Sakurai T. Minimally invasive anterior chest wall lifting technique for thoracoscopic mediastinal approach. Gen Thorac Cardiovasc Surg 2016; 64:564-7. [PMID: 27038449 DOI: 10.1007/s11748-016-0643-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/17/2016] [Indexed: 11/27/2022]
Abstract
Anterior chest wall lifting facilitates a wide view and allows easy access during thoracoscopic surgery in a supine position for anterior mediastinal lesions. We previously reported an anterior chest wall lifting method for a thymectomy that utilizes our original costal hooks. Here, we present a less invasive method that can be performed with only a needle puncture, i.e., a metal plate placed under the ribs is lifted with a wire inserted through the anterior chest wall. We have applied this novel 'T-lifting method' for 5 different cases with anterior mediastinal tumors, and found it to be simple and easy to perform, as well as less invasive for patients undergoing thoracoscopic surgery.
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Affiliation(s)
- Hiroyuki Shiono
- General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan.
| | - Tetsuki Sakamoto
- General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Teiko Sakurai
- General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan
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Sakamaki Y, Oda T, Kanazawa G, Shimokawa T, Kido T, Shiono H. Intermediate-term oncologic outcomes after video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Cardiovasc Surg 2014; 148:1230-1237.e1. [DOI: 10.1016/j.jtcvs.2014.01.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/14/2013] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
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Fukumoto K, Takatsuki S, Jinzaki M, Yamada M, Tanimoto K, Nishiyama N, Aizawa Y, Hagiwara Y, Fukuda Y, Kimura T, Miyoshi S, Kuribayashi S, Fukuda K. Three-dimensional imaging and mapping of the right and left phrenic nerves: relevance to interventional cardiovascular therapy. ACTA ACUST UNITED AC 2013; 15:937-43. [DOI: 10.1093/europace/eus439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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11
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Prognosis of phrenic nerve injury following thoracic interventions: Four new cases and a review. Clin Neurol Neurosurg 2012; 114:199-204. [DOI: 10.1016/j.clineuro.2011.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 11/20/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
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Video-Assisted Thoracoscopic Surgery Extended Thymectomy for Myasthenia Gravis Using Manual Manipulators: the Radius Surgical System. Ann Thorac Surg 2011; 92:2246-8. [DOI: 10.1016/j.athoracsur.2011.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 03/30/2011] [Accepted: 05/05/2011] [Indexed: 11/16/2022]
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Iwata T, Yasuoka T, Hanada S, Suehiro Y, Sakaki M, Nishibayashi A, Miura T. Extended thymectomy via videothoracoscopy-assisted stepwise-access sternotomy. Ann Thorac Cardiovasc Surg 2011; 17:337-40. [PMID: 21881318 DOI: 10.5761/atcs.oa.10.01568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A method of videothoracoscopy-assisted extended thymectomy procedure performed through a movable small access window is introduced. The access window can be moved stepwise and longitudinally alongside full sternotomy to be upon the dissection site. The majority of the thymectomy procedure can be directly viewed and operated from the moving window. However, partial and complete thoracoscopic maneuvers are required for dissection of the lateral-most region near the phrenic nerve and the upper poles of the thymus, respectively.
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Affiliation(s)
- Takashi Iwata
- Department of Thoracic and Cardiovascular Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
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Zieliński M, Hauer L, Kuzdzał J, Sośnicki W, Harazda M, Pankowski J, Nabiałek T, Szlubowski A. Technique of the transcervical-subxiphoid-videothoracoscopic maximal thymectomy. J Minim Access Surg 2011; 3:168-72. [PMID: 19789678 PMCID: PMC2749200 DOI: 10.4103/0972-9941.38911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 01/14/2008] [Indexed: 11/29/2022] Open
Abstract
Background: The aim of this study is to present the new technique of transcervical-subxiphoid-videothoracoscopic “maximal”thymectomy introduced by the authors of this study for myasthenia gravis. Materials and Methods: Two hundred and sixteen patients with Osserman scores ranging from I–III were operated on from 1/9/2000 to 31/12/2006 for this study. The operation was performed through four incisions: a transverse 5–8 cm incision in the neck, a 4–6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic (VTS) ports. The cervical part of the procedure was performed with an open technique while the intrathoracic part was performed using a video assisted thoracoscopic surgical (VATS) technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue was removed. Such an operation can be performed by one surgical team (the one team approach) or by two teams working simultaneously (two team approach). The early and late results as well as the incidence and localization of ectopic thymic foci have been presented in this report. Results: There were 216 patients in this study of which 178 were women and 38 were men. The ages of the patients ranged from 11 to 69 years (mean 29.7 years). The duration of myasthenia was 2–180 months (mean 28.3 months). Osserman scores were in the range of I–III. Almost 27% of the patients were taking steroids or immunosuppressive drugs preoperatively. The mean operative time was 201.5 min (120–330 min) for a one-team approach and it was 146 (95–210 min) for a two-team approach (P < 0.05). While there was no postoperative mortality, the postoperative morbidity was 12%. The incidence of ectopic thymic foci was 68.4%. The rates of complete remission after one, two, three, four and five years of follow-up were 26.3, 36.5, 42.9, 46.8 and 50.2%, respectively. Conclusion: Transcervical-subxiphoid-VTS maximal thymectomy is a complete and highly effective treatment modality for myasthenia gravis. The need for sternotomy is avoided while the completeness of the operation is retained.
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Huang CS, Cheng CY, Hsu HS, Kao KP, Hsieh CC, Hsu WH, Huang BS. Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis: Comparison by a case-matched study. Surg Today 2011; 41:338-45. [DOI: 10.1007/s00595-010-4270-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 01/14/2010] [Indexed: 12/01/2022]
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Video-assisted thoracic surgery thymectomy: the better approach. Ann Thorac Surg 2010; 89:S2135-41. [PMID: 20493997 DOI: 10.1016/j.athoracsur.2010.02.112] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/09/2010] [Accepted: 02/12/2010] [Indexed: 11/20/2022]
Abstract
Minimally invasive video-assisted thoracic surgery (VATS) thymectomy has evolved significantly over the last decade. The most common indication for VATS thymectomy is the treatment of myasthenia gravis (MG). Video-assisted thoracic surgery thymectomy results in less postoperative pain, better preserved pulmonary function, and improved cosmesis, which can be particularly important to many young female MG patients. Results of VATS thymectomy, in terms of complete stable remission from MG and symptomatic improvement, as well as safety, are comparable with conventional surgical techniques. This more patient-friendly approach would lead to wider acceptance by MG patients and their neurologists for earlier thymectomies and improved outcomes.
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Murai H, Uchiyama A, Mei FJ, Kojima M, Kira JI. Long-term effects of infrasternal mediastinoscopic thymectomy in myasthenia gravis. J Neurol Sci 2009; 287:185-7. [DOI: 10.1016/j.jns.2009.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 07/31/2009] [Accepted: 08/03/2009] [Indexed: 11/26/2022]
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Meyer DM, Herbert MA, Sobhani NC, Tavakolian P, Duncan A, Bruns M, Korngut K, Williams J, Prince SL, Huber L, Wolfe GI, Mack MJ. Comparative Clinical Outcomes of Thymectomy for Myasthenia Gravis Performed by Extended Transsternal and Minimally Invasive Approaches. Ann Thorac Surg 2009; 87:385-90; discussion 390-1. [DOI: 10.1016/j.athoracsur.2008.11.040] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 11/13/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
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Alternative choices of total and partial thymectomy in video-assisted resection of noninvasive thymomas. Surg Endosc 2007; 22:1272-7. [PMID: 17943356 DOI: 10.1007/s00464-007-9606-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 07/24/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this report is to discuss the appropriate choice of procedures for video-assisted resection of thymoma according to factors such as the presence of myasthenia gravis or location of the tumor. METHODS We evaluated the short-term results of thoracoscopic surgery for 30 consecutive cases of noninvasive thymoma. Unilateral thoracoscopic partial (or subtotal) thymectomy (UTPT) was employed in patients with nonmyasthenic thymoma localized to the unilateral mediastinum, and extended (or total) thymectomy by an infrasternal mediastinal approach (ETIS) in myasthenic cases or those in which total thymectomy was considered inevitable. RESULTS UTPT was performed on 11 nonmyasthenic patients, and ETIS on 19 (13 myasthenics and six nonmyasthenics). Three patients in the ETIS group underwent conversion to sternotomy because of pericardial dissemination, pleural adhesion, and vascular injury, respectively. The mean surgical duration was 163 min and 224 min and mean blood loss was 123 g versus 149 g for UTPT and ETIS, respectively. Post-thymomectomy myasthenia occurred in a patient after UTPT who made an excellent recovery to remission after the re-UTPT. There has not been any recurrence detected for 48 months of mean postoperative follow-up. CONCLUSIONS Our trial regarding the choice of total or partial thymectomy in thoracoscopic surgery for thymomas yielded acceptable results that warrant further investigations into long-term survival and recurrence after longer-term observation of patients undergoing these procedures.
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Manlulu A, Lee TW, Wan I, Law CY, Chang C, Garzon JC, Yim A. Video-Assisted Thoracic Surgery Thymectomy for Nonthymomatous Myasthenia Gravis. Chest 2005; 128:3454-60. [PMID: 16304299 DOI: 10.1378/chest.128.5.3454] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Minimal-access thymectomy has become increasingly popular as surgical treatment for patients with nonthymomatous myasthenia gravis (NTMG) because of its comparable efficacy, safety, and lesser degree of tissue trauma compared with conventional open surgery. We reviewed and analyzed our data on video-assisted thoracic surgery (VATS) thymectomy and present the clinical outcomes according to the Myasthenia Gravis Foundation of America classification. DESIGN A retrospective review of VATS thymectomy for NTMG in a university hospital over a 12-year period. Data were collected from the medical records and supplemented with telephone surveys. The impact of surgery and other variables potentially affecting complete stable remission (CSR) were calculated using Kaplan-Meier survival curves; comparisons between survival curves was performed using the log-rank test. RESULTS A total of 38 consecutive patients underwent VATS thymectomy for NTMG. Median postoperative stay was 3 days. Pathologic examination revealed thymic hyperplasia in 61.1% of cases, normal thymus in 22.2%, and thymic atrophy in 16.6%. There was no perioperative mortality; complications occurred in four patients. After a median follow-up of 69 months, 91.6% of patients experienced improvement, with crude CSR achieved in 22.2%. Kaplan-Meier survival curve demonstrated a 75% CSR rate at 10-year follow-up. On univariate analysis, only disease duration < or = 12 months (p = 0.03) was associated with a statistically significant improvement in CSR. CONCLUSIONS VATS thymectomy for NTMG results in symptomatic improvement in the vast majority of patients, with a high rate of CSR. The procedure is associated with low morbidity and no perioperative mortality. Future studies on thymectomy for myasthenia gravis should be reported in a standardized manner to allow accurate comparisons between results in the absence of randomized prospective trials.
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Affiliation(s)
- Anthony Manlulu
- Division of Cardiothoracic Surgery, the Chinese University of Hong Kong, SAR, China.
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Huang CS, Hsu HS, Huang BS, Lee HC, Kao KP, Hsu WH, Huang MH. Factors influencing the outcome of transsternal thymectomy for myasthenia gravis. Acta Neurol Scand 2005; 112:108-14. [PMID: 16008537 DOI: 10.1111/j.1600-0404.2005.00424.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Thymectomy is one of the current treatment strategies for patients with myasthenia gravis (MG); however, the selection criteria for surgery remain controversial. METHODS The demographic data and the surgical results of 168 patients with MG who underwent transsternal thymectomy from June 1986 to December 2000 were retrospectively reviewed. Follow-up information was obtained by review of the hospital records or telephone contact. The postoperative status of MG was assessed at the interval of 1, 3 and 6 months and then annually. The complete remission rate (CRR) between groups was compared. RESULTS A total of 168 patients, including 69 male patients and 99 female patients, with a mean age of 38.3 years (range 13-80 years), were analyzed. The symptom duration before operations was from 1 to 312 months with a mean of 33.8 months. Complete follow-up information was obtained on 154 patients (91.6%) with a mean follow-up duration of 98.9 months. Complete remission was achieved in 89 of 154 patients (57.8%) and marked clinical improvement in 47 patients (30.5%). Total improvement rate was 88.3%. Seventeen of 24 patients (70.8%) with ocular MG and 18 of 35 patients (51.4%) with thymoma had reached complete remission during the follow-up period. The CRR increased with each consecutive year and reached the plateau in the fourth postoperative year. There was no surgical mortality. The complication rate was 16.6%. Univariate analysis demonstrated that age <35 years old (P = 0.0001), symptom duration before operation <24 months (P = 0.01) and absence of preoperative steroid treatment (P = 0.04) were favorable prognostic factors. Multivariate Cox regression analysis revealed age <35 years old (odds ratio = 3.645, P = 0.001), symptom duration before operation <24 months (2.311, P = 0.041) were favorable prognostic factors for patients having transsternal thymectomy. CONCLUSIONS Transsternal thymectomy is feasible in the management of patients with MG at all stages with high improvement rate and low surgical morbidity. Those patients aged 35 years or less at operation, with symptoms developed <24 months before operation, may benefit more from thymectomy. MG patients with thymoma did as well as patients without thymoma, and 18 of 35 patients with thymoma had reached complete remission during the follow-up period. Thymectomy seems to be beneficial also for ocular MG.
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Affiliation(s)
- C-S Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Rea F, Marulli G, Bortolotti L. Robotic video-assisted thoracoscopic thymectomy. Multimed Man Cardiothorac Surg 2005; 2005:mmcts.2004.000422. [PMID: 24414027 DOI: 10.1510/mmcts.2004.000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Presentation of a minimally invasive surgical technique for thymectomy in patients affected by myasthenia gravis (MG): robotic video-assisted thoracic surgery (VATS) is a surgical technique applied to perform thymectomy and remove the entire mediastinal fat through a left transpleural approach.
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Affiliation(s)
- Federico Rea
- Division of Thoracic Surgery, University of Padua, via Giustiniani 2, 35128 Padua, Italy
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Zielinski M, Kuzdzal J, Nabialek T. Transcervical-subxiphoid-VATS "maximal" thymectomy for myasthenia gravis. Multimed Man Cardiothorac Surg 2005; 2005:mmcts.2004.000836. [PMID: 24414331 DOI: 10.1510/mmcts.2004.000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A maximally extended thymectomy is performed through four incisions: a transverse 5-8 cm incision in the neck, a 4-6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic ports. The cervical part of the procedure is performed with an open technique, the intrathoracic part of the procedure is performed with the videothoracoscopy assisted (VATS) technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue is removed. The need for sternotomy is avoided while the completeness of the operation is retained.
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Affiliation(s)
- Marcin Zielinski
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, ul. Gładkie 1, 34-500 Zakopane, Poland
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Loscertales J, Ayarra Jarne J, Congregado M, Arroyo Tristán A, Jiménez Merchán R, Girón Arjona JC, Arenas Linares C. Video-Assisted Thoracoscopic Thymectomy for the Treatment of My asthenia Gravis. ACTA ACUST UNITED AC 2004; 40:409-13. [PMID: 15458617 DOI: 10.1016/s1579-2129(06)60344-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy. PATIENTS AND METHODS Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes). RESULTS No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes). CONCLUSIONS Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety.
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Affiliation(s)
- J Loscertales
- Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Zieliński M, Kuzdzał J, Szlubowski A, Soja J. Transcervical-subxiphoid-videothoracoscopic “maximal” thymectomy—operative technique and early results. Ann Thorac Surg 2004; 78:404-9; discussion 409-10. [PMID: 15276485 DOI: 10.1016/j.athoracsur.2004.02.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND The operative technique of a transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy without sternotomy is described and the early results of the follow-up of patients operated on are analyzed. METHODS One-hundred "maximal" transcervical-subxiphoid-videothoracoscopic thymectomies were performed for nonthymomatous myasthenia gravis during a recent 32-month period (from September 1, 2000 to May 8, 2003). Patient characteristics, complications, pathologic findings, and the results of follow-up were analyzed. RESULTS The study group included 83 women and 17 men. The mean age was 29.8 years (range, 10-69 years). The mean preoperative duration of myasthenia was 2.73 years (range, 3 months to 17 years). The preoperative Osserman score was I-III, 27 patients were taking steroids preoperatively. Eleven operations were performed by two teams working simultaneously and 89 operations were performed by one surgeon including four combined thymectomy-thyroid operations in patients with myasthenia and thyroid nodules. The mean operative time for two-team approach thymectomies was 159.09 minutes (range, 140-170 minutes) and the mean operative time for the thymectomy performed by one surgeon was 199.41 minutes (range, 150-270 minutes) (p = 0.0004). There was a 15.0% (15 out of 100) postoperative morbidity and no mortality. Foci of ectopic thymic tissue were found in 71.0% of the patients and were most prevalent in the perithymic fat (37.0%) and in the aorta-pulmonary window (33.0%). The mean weight of the specimen was 78.4 g (range, 14.5-253.0 g). In 48 patients followed-up for 12 months, the improvement rate was 83.3%, the no improvement rate was 14.6%, and 1 patient died during the follow-up period. Complete remission rates were 18.8% and 32.0% after 1 and 2 years of follow-up, respectively. CONCLUSIONS We conclude that the "maximal" transcervical-subxiphoid-videothoracoscopic thymectomy is a safe operative technique, avoiding a sternotomy, performed partly in an open fashion with the extensiveness comparable with the transsternal extended and "maximal" thymectomies. The two-team approach helps to reduce the operative time. However, because of the limited time of follow-up it is too early for the final assessment of the long-term results of this method in the treatment of myasthenia gravis.
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Affiliation(s)
- Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, ul. Gladkie 1, 34-500 Zakopane, Poland.
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Marshall M. Invited commentary. Ann Thorac Surg 2004. [DOI: 10.1016/j.athoracsur.2004.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zieliński M, Kuzdzal J, Szlubowski A, Soja J. Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis. Ann Thorac Surg 2004; 78:253-8. [PMID: 15223438 DOI: 10.1016/j.athoracsur.2003.11.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influence of the technique of thymectomy on late results in the treatment of myasthenia gravis remains controversial. METHODS Results of 60 basic transsternal thymectomies and 58 extended transsternal thymectomies were compared. Both positive results (complete remissions or improvement) and negative results (no improvement, deterioration, or death from myasthenia) were analyzed. RESULTS There were no differences between both groups according to patient's characteristics and postoperative complications rate. Ectopic foci of the thymic tissue were discovered in the fat of the neck and the mediastinum in 56.9% of patients from the extended thymectomy group. The foci occurred in all areas of dissection of the neck and the mediastinum. Complete remission rates in the basic thymectomy group were 8.3%, 11.7%, 15.0%, 16.7%, 20.0%, and 21.7% after 1, 2, 3, 4, 5, and 6 years of follow-up, respectively, and 29.3%, 37.9%, 41.4%. and 46.6% after 1, 2, 3, and 4 years, respectively, in the extended thymectomy group. The differences between both groups after 1, 2, 3, and 4 years were statistically significant (p = 0.0093, p = 0.0013, p = 0.0018, and p = 0.0007, respectively). Negative results were noted in 23.3% of patients in the basic thymectomy group and in 6.9% of patients in the extended thymectomy group (p = 0.0613). No other factors had any influence on the results. CONCLUSIONS Late results, both positive and negative, were considerably better in the extended thymectomy group. The difference can be explained by the removal of ectopic foci of the thymic tissue from the neck and the mediastinum in these patients.
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Affiliation(s)
- Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland.
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Uchiyama A, Shimizu S, Murai H, Ohshima A, Konomi H, Ogura Y, Ishikawa N, Yamashita H, Matsumoto S, Kuroki S, Tanaka M. Infrasternal mediastinoscopic surgery for anterior mediastinal masses. Surg Endosc 2004; 18:843-6. [PMID: 14755356 DOI: 10.1007/s00464-003-8191-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 12/18/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infrasternal mediastinoscopic surgery is a new alternative to the thoracoscopic approach for patients with anterior mediastinal masses. METHODS We applied this technique to 18 thymectomies, one thymomectomy, and one cystectomy in a total of 20 patients with anterior mediastinal masses and then assessed the surgical results. RESULTS Infrasternal mediastinoscopic surgery was accomplished in 18 of the 20 patients (90%). The pathological diagnoses included 13 Masaoka stage I thymomas, one stage II thymoma, two stage III thymomas, one thymic cyst, one pericardial cyst, one thymic granuloma, and one mature teratoma. Two patients with stage III thymoma required conversion to sternotomy, one for invasion into the innominate vein and the other for invasion into the pericardium. There was no surgically related mortality or complications in any patients. CONCLUSION Infrasternal mediastinoscopic surgery is safe and feasible for stage I thymoma and other benign tumors in the anterior mediastinum.
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Affiliation(s)
- A Uchiyama
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan.
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Loscertales J, Ayarra Jarne J, Congregado M, Arroyo Tristán A, Jiménez Merchán R, Girón Arjona J, Arenas Linares C. Timectomía videotoracoscópica para el tratamiento de la miastenia gravis. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75560-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ohta M, Hirabayasi H, Okumura M, Minami M, Matsuda H. Thoracoscopic thymectomy using anterior chest wall lifting method. Ann Thorac Surg 2003; 76:1310-1. [PMID: 14530043 DOI: 10.1016/s0003-4975(03)00445-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We performed a thoracoscopic resection of thymus and thymoma using a novel method whereby the chest wall was lifted by costal hooks placed on the bilateral third ribs. Since the thymus and fat tissue were also elevated, the mediastinal dissection was started at the underlying vessels and pericardium. This technique conforms to the purpose of endoscopic surgery, as it maximizes the operative field and minimizes chest wall trauma. We have applied this approach to benign mediastinal tumor and stage I thymoma with satisfactory results.
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Affiliation(s)
- Mitsunori Ohta
- Department of General Thoracic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan.
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Abstract
BACKGROUND Debate continues regarding the effectiveness of thymectomy in the treatment of nonthymomatous autoimmune myasthenia gravis primarily because there have been no controlled prospective studies. The debate is compounded by the lack of recognition that all thymectomies are not equal in extent or effectiveness and by the fact that all the studies are retrospective without common definitions of myasthenia gravis manifestations or response to therapy. In addition, the analysis of data is often inappropriate. REVIEW SUMMARY Evidence is presented demonstrating that the extent of the various thymic resectional techniques is very variable and often incomplete and that the more complete the thymic resection the better the results. The indications for thymectomy, the selection of the technique of the resection, the reoperations issue, the perioperative management of the myasthenia gravis patient, morbidity and mortality, and appropriate methods of outcome research are also reviewed. CONCLUSION In view of the impressive results associated with a complete thymic resection in the treatment of myasthenia gravis, patients should not be denied this operation because of lack of prospective proof to-date, and when a thymectomy is performed a total resection is indicated.
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Affiliation(s)
- Alfred Jaretzki
- College of Physicians and Surgeons, Columbia University, Department of Surgery, Columbia Presbyterian Medical Center, New York, NY, USA.
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Abstract
Important progress has been made in our understanding of the cellular and molecular processes underlying autoimmune neuromuscular diseases that has led us to identify targets for rational therapeutic intervention. Although antigen-specific immunotherapy is not yet available, old and new immunomodulatory treatments, alone or in combination, provide effective immunotherapy for most autoimmune disorders. In parallel, the achievements of molecular medicine provide more specific yet largely experimental therapeutic tools that need to be tested in the human diseases. Here we review the principles and targets of immunotherapy for autoimmune neuromuscular disorders, address applications and practical guidelines, and give an outlook on future developments.
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Jaretzki A. Injury to the phrenic and recurrent nerves needs to be avoided in the performance of thymectomy for myasthenia gravis. Ann Thorac Surg 2002; 74:633; author reply 634. [PMID: 12173873 DOI: 10.1016/s0003-4975(02)03623-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Uchiyama A, Shimizu S, Tanaka M. Reply. Ann Thorac Surg 2002. [DOI: 10.1016/s0003-4975(02)03625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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