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Waheed W, Bacopulos A, Seyam M, Kooperkamp H, Moin M, Malik T, Tandan R. Physiological and pathological roles of the thymus and value of thymectomy in myasthenia gravis: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:31. [PMID: 38881805 PMCID: PMC11177005 DOI: 10.21037/med-23-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/15/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective Myasthenia gravis (MG) is a well-elucidated autoimmune disorder affecting the neuromuscular junction. Given the relationship between MG and thymic pathologies, with T cell and antibody-mediated pathogenesis, surgical (i.e., thymectomy) and non-surgical approaches remain a mainstay of management of the disease. This review seeks to outline the involvement of the thymus in the development of lymphocytes leading to MG. Methods Different databases were searched exploring the role of thymectomy in treatment and outcomes in various MG patient subpopulations, including in ocular versus generalized disease, different age groups, and antibody status. Key Content and Findings Overall, the findings of multiple studies and reviews provide evidence to support the efficacy and long-term success of thymectomy in the management of MG; outcomes have included remission status, symptom severity, and need for adjunctive therapy. However, the heterogeneity in the MG population suggests that there are multiple factors that may confound the results of thymectomy and still need further examination. Separately, other autoimmune diseases develop following thymectomy, and further research is required to elucidate this susceptibility. Finally, our review will discuss the different surgical approaches for thymectomy, including their advantages, limitations, and perioperative complications. Conclusions Overall, in light of the known pathogenesis and association of the thymus with MG, thymectomy remains an extremely effective approach for long-term management and improved clinical outcomes.
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Affiliation(s)
- Waqar Waheed
- Department of Neurological Sciences, University of Vermont Robert D. Larner, MD College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Agnes Bacopulos
- Department of Neurological Sciences, University of Vermont Robert D. Larner, MD College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Muhannad Seyam
- Department of Neurological Sciences, University of Vermont Robert D. Larner, MD College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Hannah Kooperkamp
- Division of Thoracic and Cardiac Surgery, University of Vermont Robert D. Larner, MD College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Maryam Moin
- Department of Neurology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Tariq Malik
- Department of Anesthesiology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Rup Tandan
- Department of Neurological Sciences, University of Vermont Robert D. Larner, MD College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
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2
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Mayer N, Kestenholz P, Minervini F. Surgical access to the mediastinum- all roads lead to Rome: a literature review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:28. [PMID: 38881816 PMCID: PMC11176995 DOI: 10.21037/med-23-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/11/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective The mediastinum is a complex, heterogeneous area, which leads vertically across the thoracic cavity between the bilateral mediastinal pleurae, connecting the head and neck region with the thoracic cavity. Different classifications have been published to differentiate between the so-called mediastinal compartments while the most used classification surely is the 4-compartments Gray`s classification, dividing it into the superior, anterior, middle and posterior mediastinum. Mediastinal abnormalities include infections (mediastinitis) and solid or cystic mediastinal masses. These masses can be divided into benign and malignant lesions originating from mediastinal structures/organs or represent manifestations of metastatic disease, often metastatic non-small cell lung cancer (NSCLC). This review aims to explore the different mediastinal pathologies along with indications and surgical approaches. Methods We performed literature research in PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases. Only papers written in English were included. Key Content and Findings Depending on the indication for surgical intervention and the localization of the pathology, surgical approach may differ immensely. Mediastinal staging of lung cancer, primary lesions of the mediastinum, mediastinitis and traumatic mediastinal injuries display the most frequent indications for mediastinal surgery. Surgical approaches trend towards minimally invasive, video- or robotic-assisted techniques and are becoming increasingly refined to adapt to the special characteristics of the mediastinum. However, certain indications still require open access for best possible mediastinal exposure or oncological reasons. Conclusions To guide optimal surgical approach selection to the mediastinum, the following overview will present all published surgical approaches to the mediastinum and discuss their practical relevance and indications aiming to help surgeons in the management of patients with mediastinal pathologies who should undergo surgery.
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Affiliation(s)
- Nora Mayer
- Division of Thoracic Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Peter Kestenholz
- Division of Thoracic Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
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Cabezón-Gutiérrez L, Pacheco-Barcia V, Carrasco-Valero F, Palka-Kotlowska M, Custodio-Cabello S, Khosravi-Shahi P. Update on thymic epithelial tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:33. [PMID: 38881809 PMCID: PMC11176988 DOI: 10.21037/med-23-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/14/2024] [Indexed: 06/18/2024]
Abstract
Background and Objective Thymoma, thymic carcinoma and thymic neuroendocrine tumors originate from the epithelial cells of the thymus and account for the thymic epithelial tumors (TETs). Although TETs are uncommon, they are the most frequent tumor type in the anterior mediastinum. Multidisciplinary approach is essential for their correct management. The aim of the present review is to summarize the update management for TETs. Methods For this review, we searched in Excerpta Medica database (EMBASE) and MEDLINE until 6 September 2023. The terms used in the search included thymoma, thymic carcinoma, thymic epithelial tumors, management, immunotherapy, multiple tyrosine kinases inhibitors. Key Content and Findings The therapeutic approach is based on histology and tumor stage and may involve surgery with or without neoadjuvant or adjuvant treatment. In the metastatic setting, platinum-based chemotherapy is the standard of care and patients who do not respond to first-line treatment have limited treatment options mainly because of the poor efficacy shown in subsequent lines of therapy. Conclusions Future research should focus on identifying predictive biomarkers for patients with TETs, and should implement multicenter collaborations and appropriate clinical trials tailored for rare tumor types. Immune check point inhibitors, mammalian target of rapamycin (mTOR) and antiangiogenic multikinase inhibitors have also been studied in this clinical setting.
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Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology, Torrejón University Hospital, Madrid, Spain
- Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain
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4
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Peng H, He Y, Sheng S, Maitiyasen M, Li J, Liu Y, Chen J, Hou X, Song H, Yi J. Clinical efficiency of three-port inflatable robot-assisted thoracoscopic surgery in mediastinal tumor resection. World J Surg Oncol 2024; 22:83. [PMID: 38523264 PMCID: PMC10962077 DOI: 10.1186/s12957-024-03357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Aimed to assess clinical effect of three-port inflatable robot-assisted thoracoscopic surgery in mediastinal tumor resection by comparing results of the robot group with the video group. METHODS Retrospectively analyze 179 patients diagnosed with anterior mediastinal tumor from May 2017 to August 2021. Two groups were divided according to the surgical approach, including 92 cases in the RATS group and 87 cases in the VATS group. The results were analyzed between two groups with variables of age, sex, BMI, tumor size, and diagnosis. Perioperative clinical data was gathered to compare. RESULT There were no significant differences between the 2 groups with regards to demographic data and clinical features. There were no significant differences inoperative time and duration of chest tube via RATS vs. VATS. The intraoperative blood loss was statistically significantly different among the RATS and VATS groups (75.9 ± 39.6 vs. 97.4 ± 35.8 ml p = 0.042). The postoperative stay of patients in RATS group were significantly shorter than that in VATS group (2.3 ± 1.0 vs. 3.4 ± 1.4 day p = 0.035), CONCLUSION: Three-port inflatable robot-assisted thoracoscopic surgery for mediastinal tumor is feasible and reliable it is more advantageous, and it provides the surgeon with advice on treatment choice.
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Affiliation(s)
- Hao Peng
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - YuanPeng He
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Siqi Sheng
- Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Maierhaba Maitiyasen
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Jingfeng Li
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Yvxuan Liu
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Jing Chen
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University Of Chinese Medicine, Nanjing, Jiangsu Province, PR China
| | - Xinyu Hou
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China
| | - Haizhu Song
- Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China.
| | - Jun Yi
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu Province, PR China.
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5
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Taje R, Peer M, Gallina FT, Ambrogi V, Sharbel A, Melis E, Elia S, Idit M, Facciolo F, Patirelis A, Sorge R, Pompeo E. Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy. J Clin Med 2024; 13:1841. [PMID: 38610606 PMCID: PMC11012820 DOI: 10.3390/jcm13071841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.
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Affiliation(s)
- Riccardo Taje
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michael Peer
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Filippo Tommaso Gallina
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Azzam Sharbel
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Stefano Elia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Matot Idit
- Department of Anaesthesia and Intensive Care, Ichilov Medical Center, Tel Aviv 6423906, Israel;
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Alexandro Patirelis
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Roberto Sorge
- Department of Biostatistics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Eugenio Pompeo
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
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6
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Sicolo E, Zirafa CC, Romano G, Brandolini J, De Palma A, Bongiolatti S, Gallina FT, Ricciardi S, Maestri M, Guida M, Morganti R, Carleo G, Mugnaini G, Tajè R, Calabró F, Lenzini A, Davini F, Cardillo G, Facciolo F, Voltolini L, Marulli G, Solli P, Melfi F. National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes. Cancers (Basel) 2024; 16:406. [PMID: 38254894 PMCID: PMC10814766 DOI: 10.3390/cancers16020406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Thymectomy is the gold standard in the treatment of thymic neoplasm and plays a key role in the therapeutic path of myasthenia gravis. For years, sternotomy has been the traditional approach for removing anterior mediastinal lesions, although the robotic thymectomy is now widely performed. The literature is still lacking in papers comparing the two approaches and evaluating long-term oncological and neurological outcomes. This study aims to analyze the postoperative results of open and robotic thymectomy for thymic neoplasms in myasthenic patients. Surgical, oncological and neurological data of myasthenic patients affected by thymic neoplasms and surgically treated with extended thymectomy, both with the open and the robotic approach, in six Italian Thoracic Centers between 2011 and 2021 were evaluated. A total of 213 patients were enrolled in the study: 110 (51.6%) were treated with the open approach, and 103 (48.4%) were treated with robotic surgery. The open surgery, compared with the robotic, presented a shorter operating time (p < 0.001), a higher number of postoperative complications (p = 0.038) and longer postoperative hospitalization (p = 0.006). No other differences were observed in terms of surgical, oncological or neurological outcomes. The robotic approach can be considered safe and feasible, comparable to the open technique, in terms of surgical, oncological and neurological outcomes.
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Affiliation(s)
- Elisa Sicolo
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Jury Brandolini
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (J.B.); (P.S.)
| | - Angela De Palma
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Stefano Bongiolatti
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy; (S.R.); (G.C.)
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (M.M.)
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy; (M.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Graziana Carleo
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Giovanni Mugnaini
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Riccardo Tajè
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Fabrizia Calabró
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Alessandra Lenzini
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy; (S.R.); (G.C.)
| | - Francesco Facciolo
- Thoracic Surgery Unit IRCCS Regina Elena National Cancer Center, 00144 Rome, Italy; (F.T.G.); (R.T.); (F.F.)
| | - Luca Voltolini
- Thoracic Surgery Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, 50134 Florence, Italy; (S.B.); (G.M.); (L.V.)
| | - Giuseppe Marulli
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy; (A.D.P.); (G.C.); (G.M.)
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (J.B.); (P.S.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery—Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (G.R.); (F.C.); (A.L.); (F.D.); (F.M.)
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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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E H, Yang C, Zhang L, Xia L, Xu L, Song N, Hu X, Zhu Y, Chen C, Zhao D. Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience. Updates Surg 2023:10.1007/s13304-023-01702-5. [PMID: 38060172 DOI: 10.1007/s13304-023-01702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The advent of robot-assisted thoracoscopic surgery (RATS) has completely revolutionized the modality of thymectomy, which could reportedly achieve equivalent efficacy compared with a minimally invasive approach. This study was conducted to further compare the perioperative outcomes between these two modalities. METHODS A retrospective single-center study that included patients receiving either a robotic or video-assisted thoracoscopic (VAT) thymectomy between February 2021 and January 2023 was conducted. All the patients were pathologically confirmed with thymic epithelial tumors. Clinical and pathological characteristics and perioperative outcomes were collected and compared between these two cohorts. RESULTS A total of 190 patients were included in this study, with 61 (32.1%) and 129 (67.9%) receiving robotic and video-assisted thymectomy, respectively. The clinicopathological characteristics were not significantly different between these 2 groups. The size of the resected specimens in the RATS cohort was larger than the VATS cohort [median (IQR), 13.0 (8.0-16.0) vs. 9.0 (6.7-12.0) cm, p < 0.001], while the procedural duration was longer for the RATS group than its counterpart [median (IQR), 105 (85-143) vs. 85 (69-115) min, p = 0.001]. Moreover, no other significant difference was observed between these two groups. Since more than half of the robotic thymectomy was performed using a subxiphoid approach, a subgroup analysis was further conducted. Similarly, the robotic group through a subxiphoid approach harbored a longer procedural duration, and the size of the specimens obtained was larger than the VATS group [median (IQR), 14.0 (11.0-16.5) vs. 12.5 (8.5-15.0) cm, p = 0.061]. CONCLUSIONS The early clinical efficacy of robotic thymectomy was proven comparable to the established VATS approach, and such a modality might have strength when obtaining larger specimens, which could contribute to improving long-term efficacy. Despite the longer procedural duration recorded in the early stage of conducting robotic thymectomy, further accumulation would help decrease the time.
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Affiliation(s)
- Haoran E
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Lang Xia
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China.
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Hien VV, Tu NH, Thu ND. Propofol TCI or sevoflurane anesthesia without muscle relaxant for thoracoscopic thymectomy in myasthenia gravis patients: a prospective, observational study. BMC Anesthesiol 2023; 23:349. [PMID: 37865733 PMCID: PMC10589925 DOI: 10.1186/s12871-023-02296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) patients interact unpredictably with anesthetic agents, including neuromuscular blocking agents. Here, we investigate the effectiveness of general anesthesia without muscle relaxants using either propofol via target-controlled infusion systems (TCI) or sevoflurane in MG patients undergoing thoracoscopic thymectomy. METHODS This prospective, open-label, observational study was conducted in a university hospital. We included 90 myasthenic patients undergoing thoracoscopic thymectomy with general anesthesia. Patients received induction and maintenance anesthesia with propofol TCI (group P, n = 45) or induction with propofol 2-3 mg.kg-1 and maintenance anesthesia with sevoflurane (group S, n = 45). In both groups, the procedure was performed under the guidance of entropy with sufentanil but not a muscle relaxant. Intubation conditions, hemodynamic changes, respiratory function, neuromuscular transmission, arterial blood gas, and complications were evaluated. RESULTS All patients achieved good intubation conditions. Hemodynamic instability was more frequent in group S than in group P, mostly in the induction stage, and was controllable. The reduction in the intraoperative train-of-four ratio from baseline at 30 min, 60 min, and 90 min in group S was 10.3%, 14.2%, and 14.3%, respectively, significantly higher than that in group P (6.8%, 7.2%, and 8.4%, respectively), which completely recovered at the end of the surgery. All patients were extubated in the operating room without complications. No other significant differences between the groups were observed. CONCLUSIONS Anesthesia with propofol TCI or sevoflurane without muscle relaxants in MG patients offered safe and effective conditions for thoracoscopic thymectomy. Sevoflurane achieved higher levels of intraoperative muscular relaxation than propofol TCI. Postoperative neuromuscular function was not affected by these anesthetics.
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Affiliation(s)
- Vo Van Hien
- Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, No.261 Phung Hung Street, Ha Dong District, Hanoi, 12108, Vietnam
- Department of Anesthesiology, National Burn Hospital, Vietnam Military Medical University, No.263 Phung Hung Street, Ha Dong District, Hanoi, 12108, Vietnam
| | - Nguyen Huu Tu
- Department of Anesthesia and Critical Care, Hanoi Medical University, No.1 Ton That Tung Street, Dong Da District, Hanoi, 116177, Vietnam
| | - Nguyen Dang Thu
- Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, No.261 Phung Hung Street, Ha Dong District, Hanoi, 12108, Vietnam.
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8553, Japan.
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10
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Zeng L, He T, Hu J. Minimally invasive thoracic surgery: robot-assisted versus video-assisted thoracoscopic surgery. Wideochir Inne Tech Maloinwazyjne 2023; 18:436-444. [PMID: 37868280 PMCID: PMC10585455 DOI: 10.5114/wiitm.2023.128714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/12/2023] [Indexed: 10/24/2023] Open
Abstract
Minimally invasive techniques have been widely applied in general thoracic surgery. Compared with video-assisted thoracoscopic surgery (VATS), due to its theoretic superiority, robotic surgery is challenging the traditional position of VATS. With its unique advantages, including 3D vision and a high-freedom endowrist, it leads to easier lymph node dissection, more convenient blood vessel dissection, a shorter learning curve and competence for the completion of complex surgery. However, as a new surgical technology, the safety and efficacy of robotic-assisted thoracoscopic surgery (RATS) still need to be further verified. Thus, in this article, we review and summarize the application of RATS versus VATS in general thoracic surgery.
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Affiliation(s)
- Liping Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tianyu He
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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11
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Petroncini M, Solli P, Brandolini J, Lai G, Antonacci F, Garelli E, Kawamukai K, Forti Parri SN, Bonfanti B, Dolci G, Bertoglio P. Early Postoperative Results after Thymectomy for Thymic Cancer: A Single-Institution Experience. World J Surg 2023; 47:1978-1985. [PMID: 37079104 PMCID: PMC10310559 DOI: 10.1007/s00268-023-06996-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients' characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. METHODS We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. RESULTS We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien-Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. CONCLUSIONS Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.
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Affiliation(s)
- Matteo Petroncini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Jury Brandolini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giulia Lai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Filippo Antonacci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Elena Garelli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Kenji Kawamukai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Sergio Nicola Forti Parri
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Barbara Bonfanti
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giampiero Dolci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
- Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
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12
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Eichhorn M, Rotärmel A, Haag J, Baum P, Winter H. [Robot-assisted Thoracic Surgery: Learning Curve and Cost Analysis in a German High-Volume Centre]. Zentralbl Chir 2023; 148:S26-S32. [PMID: 36108654 DOI: 10.1055/a-1921-9058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Robot-assisted thoracic surgery (RATS) is a rapidly evolving surgical technique in Europe. The aim of the study was to analyse the learning curve and safety during the establishment of a RATS-program at a high-volume thoracic surgery centre and to quantify the costs of the surgical procedure in Germany. Within a period of 33 months, 255 patients were prospectively enrolled in the study and all perioperative process times and complications were recorded. Mediastinal procedures were performed in 46%, anatomical lung resections in 38%, wedge resections in 7% and diaphragm plications in 6% of patients. The mean operating time was 130 min and the total length of stay was 7 days. The conversion rate was 3.2% and 30-day mortality 1.2%. Mean costs for surgical consumables per intervention amounted to 2,039 €; the average reimbursement was 9,568 €. In summary, RATS can be safely established, performed and trained with low complication rates and acceptable costs for consumables.
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Affiliation(s)
- Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Translational Lung Research Center Heidelberg, Heidelberg, Deutschland
| | - André Rotärmel
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Johannes Haag
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Philip Baum
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Translational Lung Research Center Heidelberg, Heidelberg, Deutschland
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13
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Ochi T, Suzuki H, Hirai Y, Yamanaka T, Matsumoto H, Kaiho T, Inage T, Ito T, Tanaka K, Sakairi Y, Yoshino I. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for mediastinal lesions. J Thorac Dis 2023; 15:3840-3848. [PMID: 37559661 PMCID: PMC10407470 DOI: 10.21037/jtd-23-377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Robot-assisted thoracic surgery (RATS) has become widely used for mediastinal procedures since 2018 when it was included in insurance coverage in Japan. Few studies have compared the surgical outcomes of RATS with the more established video-assisted thoracic surgery (VATS) approach to mediastinal surgery. We aimed to compare the perioperative outcomes of VATS and RATS to examine the advantages of the RATS approach in a single institutional cohort. METHODS A total of 144 patients who underwent VATS and 46 who underwent RATS mediastinal surgery between 2014 and 2022 were enrolled. We compared clinicopathological features such as age, sex, smoking history, respiratory function, surgical field, laterality, surgical procedure, board certification of the surgeon, and histology between the two groups. Perioperative outcomes including operation time, volume of blood lost, number of conversion cases to open surgery, duration of chest drainage, postoperative hospital stay, and postoperative complications were also reviewed. RESULTS The comparison of patient characteristics between the groups showed significant differences in median age (VATS, 52.5 years; RATS, 67.0 years; P=0.001), combined resection of surrounding tissues of the tumor (VATS, 2.1%; RATS, 10.9%; P=0.02), board certification of the surgeon (VATS, 53.5%; RATS, 100.0%; P<0.001), and histology (RATS group had a higher percentage of thymic epithelial tumors, P=0.01). Regarding perioperative outcomes, the median operation time was 120 min in the VATS group and 88 min in the RATS group, showing a significant difference (P=0.03). There were no significant differences in the volume of blood lost, incidence of conversion to open chest surgery, duration of chest drainage, postoperative length of stay in hospital, and incidence of perioperative complications. In the perioperative outcomes of cases operated on by board-certified surgeons, the median operation time (VATS, 117 min; RATS, 88 min; P=0.02) and median postoperative length of stay in hospital (VATS, 7 days; RATS, 6 days; P=0.001) showed significant differences, while other postoperative outcomes were not significantly different. CONCLUSIONS RATS for mediastinal surgery is as safe as the VATS approach and may result in a shorter operative time and postoperative hospital stay. Further analysis of RATS for mediastinal surgery in a larger cohort is warranted.
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Affiliation(s)
| | | | - Yuki Hirai
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Yamanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroki Matsumoto
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taisuke Kaiho
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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14
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Menghesha H, Schroeter M, Nelke C, Ruck T, Schlachtenberger G, Welskop C, Camo A, Heldwein M, Bennink G, Wahlers T, Bölükbas S, Doerr F, Hekmat K. The impact of thymectomy in subgroups of Myasthenia gravis patients: a single center longitudinal observation. Neurol Res Pract 2023; 5:24. [PMID: 37316910 DOI: 10.1186/s42466-023-00252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) is a rare neuromuscular disorder. Symptoms can range from ptosis only to life threatening myasthenic crisis. Thymectomy is recommended for anti-acetylcholine receptor-antibody positive patients with early-onset MG. Here, we investigated prognostic factors shaping therapeutic outcomes of thymectomy to improve patient stratification. METHODS We retrospectively collected single-center data from a specialized center for MG from all consecutive adult patients that underwent thymectomy from 01/2012 to 12/2020. We selected patients with thymoma-associated and non-thymomatous MG for further investigations. We analyzed the patient collective regarding perioperative parameters in relation to the surgical approach. Furthermore, we investigated the dynamics of the anti-acetylcholine receptor-antibody titers and concurrent immunosuppressive therapies, as well as the therapeutic outcomes in dependence of clinical classifications. RESULTS Of 137 patients 94 were included for further analysis. We used a minimally invasive approach in 73 patients, whereas 21 patients underwent sternotomy. A total of 45 patients were classified as early-onset MG (EOMG), 28 as late-onset MG (LOMG) and 21 as thymoma-associated MG (TAMG). The groups differed in terms of age at diagnosis (EOMG: 31.1 ± 12.2 years; LOMG: 59.8 ± 13.7 years; TAMG: 58.6 ± 16.7 years; p < 0.001). Patients with EOMG and TAMG were more often female than patients in the LOMG group (EOMG: 75.6%; LOMG: 42.9%; TAMG: 61.9%; p = 0.018). There were no significant differences in outcome scores (quantitative MG; MG activities of daily living; MG Quality of Live) with a median follow-up of 46 months. However, Complete Stable Remission was achieved significantly more frequently in the EOMG group than in the other two groups (p = 0.031). At the same time, symptoms seem to improve similarly in all three groups (p = 0.25). CONCLUSION Our study confirms the benefit of thymectomy in the therapy of MG. Both, the concentration of acetylcholine receptor antibodies and the necessary dosage of cortisone therapy show a continuous regression after thymectomy in the overall cohort. Beyond EOMG, groups of LOMG and thymomatous MG responded to thymectomy as well, but therapy success was less pronounced and delayed compared to the EOMG subgroup. Thymectomy is a mainstay of MG therapy to be considered in all subgroups of MG patients investigated.
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Affiliation(s)
- Hruy Menghesha
- Department of Thoracic Surgery, University Medical Center Essen - Ruhrlandclinic, Tüschener Weg 40, 45239, Essen, Germany.
| | - Michael Schroeter
- Faculty of Medicine, Department of Neurology, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Georg Schlachtenberger
- Faculty of Medicine, Department of Cardiothoracic Surgery, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Clara Welskop
- Faculty of Medicine, University of Cologne, Joseph-Stelzmann-Strasse 20, 50931, Cologne, Germany
| | - Amina Camo
- Faculty of Medicine, University of Cologne, Joseph-Stelzmann-Strasse 20, 50931, Cologne, Germany
| | - Matthias Heldwein
- Faculty of Medicine, Department of Cardiothoracic Surgery, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Gerardus Bennink
- Faculty of Medicine, Department of Cardiothoracic Surgery, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Faculty of Medicine, Department of Cardiothoracic Surgery, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery, University Medical Center Essen - Ruhrlandclinic, Tüschener Weg 40, 45239, Essen, Germany
| | - Fabian Doerr
- Department of Thoracic Surgery, University Medical Center Essen - Ruhrlandclinic, Tüschener Weg 40, 45239, Essen, Germany
| | - Khosro Hekmat
- Faculty of Medicine, Department of Cardiothoracic Surgery, University of Cologne, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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15
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Alqudah O, Purmessur R, Hogan J, Saad H, Fuentes-Warr J, Francis J, Thandayuthapani S, Kouritas V. Robotic resection of anterior mediastinal masses >10 cm: a case series. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:29. [PMID: 37701644 PMCID: PMC10493617 DOI: 10.21037/med-22-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/17/2023] [Indexed: 09/14/2023]
Abstract
Background Robot-assisted thoracic surgery (RATS) for intrathoracic pathology and especially for mediastinal mass resection has been increasingly accepted as an alternative method to open sternotomy and video-assisted thoracic surgery (VATS). However, the utilization of this approach for complex and advanced in size cases needs more clinical evidence. We are presenting a series of 4 patients who had resection of >10 cm mediastinal masses via RATS. Cases Description The mean age was 76.25±10.3 years and 3 were males (75%). All masses were positron emission tomography (PET) positive, and 1 patient had positive Acetyl-cholinesterase antibodies and myasthenia gravis (MG). All patients underwent RATS resection via DaVinci® X system. The dissections were conducted with spatula and/or Maryland bipolar forceps. In 2 cases, the resection was done with bilateral docking, and in 1 case, a drain was not inserted at the end. In 1 patient, pericardial resection was necessitated. All masses were thymomas with 1 dimension measured >10 cm on pathology. All patients were discharged on day 1 or 2 postoperatively with uneventful recoveries. There was no in-hospital, 30- or 90-day mortality. All patients were found to be without issues on follow-up. Conclusions This report shows that RATS is safe and can be offered in the management of >10 cm anterior mediastinal masses. The previous size limit of the tumor for minimally invasive and especially RATS approach of 5 cm should be challenged.
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Affiliation(s)
- Obada Alqudah
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Rhusmi Purmessur
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - John Hogan
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Haisam Saad
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Joana Fuentes-Warr
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jonathon Francis
- Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Vasileios Kouritas
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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Zhang Y, Lin D, Aramini B, Yang F, Chen X, Wang X, Wu L, Huang W, Fan J. Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment. Cancers (Basel) 2023; 15:cancers15071953. [PMID: 37046614 PMCID: PMC10093507 DOI: 10.3390/cancers15071953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Thymoma and thymic carcinoma are the most common tumors of the anterior mediastinum and a relatively rare type of thoracic cancer. The prerequisite for surgery is clinical staging and operative evaluation, both of which are based on medical imaging. The best strategy for treating a thymic epithelial tumor is surgical resection of the organ and surrounding tissue. Thymectomy modalities vary, including open surgery and minimally invasive surgery, and surgeons have used various innovations to better meet the needs of the procedure; therefore, it is critical to select the appropriate procedure based on the patient's characteristics. Evaluation of resectability is the first step of surgical resection for thymic tumors without distant metastasis. The decision regarding unresectability should be made carefully. During subsequent chemotherapy or chemoradiotherapy, reevaluation of whether an area is resectable or not remains essential. Despite numerous technological advances in the surgical treatment of thymic tumors, several contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of video-assisted thoracoscopic approaches, the evaluation of resectability, minimally invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy for thymic tumors, debulking surgery, and salvage surgery. In solving these problems, the surgeon's judgment, surgical experience, and surgical skills are especially important.
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Affiliation(s)
- Yue Zhang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dong Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences-DIMEC of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 47121 Forlì, Italy
| | - Fu Yang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Chen
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xing Wang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiang Fan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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17
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Xu C, Zhang Y, Wang W, Wang Q, Li Z, Song Z, Wang J, Yu J, Liu J, Zhang S, Cai X, Wu M, Zhan P, Liu H, Lv T, Miao L, Min L, Li J, Liu B, Yuan J, Jiang Z, Lin G, Chen X, Pu X, Rao C, Lv D, Yu Z, Li X, Tang C, Zhou C, Zhang J, Guo H, Chu Q, Meng R, Liu X, Wu J, Hu X, Fang M, Zhou J, Zhu Z, Chen X, Pan W, Pang F, Zhou Y, Jian Q, Wang K, Wang L, Zhu Y, Yang G, Lin X, Cai J, Liang L, Feng H, Wang L, Du Y, Yao W, Shi X, Niu X, Yuan D, Yao Y, Huang J, Zhang Y, Sun P, Wang H, Ye M, Wang D, Wang Z, Hao Y, Wang Z, Wan B, Lv D, Yu G, Li A, Kang J, Zhang J, Zhang C, Chen H, Shi L, Ye L, Wang G, Wang Y, Gao F, Zhou W, Hu C, Wei J, Li B, Li Z, Li Y, Liu Z, Yang N, Wu L, Wang Q, Huang W, Hong Z, Wang G, Fang M, Fang Y, Zhu X, Du K, Ji J, Shen Y, Zhang Y, Ma S, Song Y, Lu Y, Liu A, Fang W, Zhong W. Chinese expert consensus on the diagnosis and treatment of thymic epithelial tumors. Thorac Cancer 2023; 14:1102-1117. [PMID: 36924056 PMCID: PMC10125784 DOI: 10.1111/1759-7714.14847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
Thymic epithelial tumors (TETs) are a relatively rare type of thoracic tumor, accounting for less than 1% of all tumors. The incidence of TETs is about 3.93/10000 in China, slightly higher than that of European and American countries. For resectable TETs, complete surgical resection is recommended. Radiotherapy or chemotherapy may be used as postoperative adjuvant treatment. Treatment for advanced, unresectable TETs consist mainly of radiotherapy and chemotherapy, but there is a lack of standard first- and second-line treatment regimens. Recently, targeted therapies and immune checkpoint inhibitors have shown promising outcomes in TETs. Based on the currently available clinical evidences and the opinions of the national experts, the Thymic Oncology Group of Yangtze River Delta Lung Cancer Cooperation Group (East China LUng caNcer Group, ECLUNG; Youth Committee) established this Chinese expert consensus on the clinical diagnosis and treatment of TETs, covering the epidemiology, diagnosis, treatment, prognosis and follow-up of TETs.
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Affiliation(s)
- Chunwei Xu
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, People's Republic of China.,Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China.,Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yongchang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Wenxian Wang
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Qian Wang
- Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, People's Republic of China
| | - Ziming Li
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhengbo Song
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Jiandong Wang
- Department of Pathology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Jinpu Yu
- Department of Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Jingjing Liu
- Department of Thoracic Cancer, Jilin Cancer Hospital, Jilin, People's Republic of China
| | - Shirong Zhang
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiuyu Cai
- Department of VIP Inpatient, Sun Yet-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ming Wu
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Cancer Center, Zhejiang University, Hangzhou, People's Republic of China
| | - Ping Zhan
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Hongbing Liu
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Liyun Miao
- Department of Respiratory Medicine, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Lingfeng Min
- Department of Respiratory Medicine, Clinical Medical School of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, People's Republic of China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Baogang Liu
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhansheng Jiang
- Derpartment of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Gen Lin
- Department of Medical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xiaohui Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xingxiang Pu
- Department of Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Chuangzhou Rao
- Department of Radiotherapy and Chemotherapy, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Dongqing Lv
- Department of Pulmonary Medicine, Taizhou Hospital of Wenzhou Medical University, Taizhou, People's Republic of China
| | - Zongyang Yu
- Department of Respiratory Medicine, the 900th Hospital of the Joint Logistics Team (the Former Fuzhou General Hospital), Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiaoyan Li
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuanhao Tang
- Department of Medical Oncology, Peking University International Hospital, Beijing, People's Republic of China
| | - Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University(The First Affiliated Hospital of Guangzhou Medical University), Guangzhou, People's Republic of China
| | - Junping Zhang
- Department of Thoracic Oncology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rui Meng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xuewen Liu
- Department of Oncology, the Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jingxun Wu
- Department of Medical Oncology, the First Affiliated Hospital of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Xiao Hu
- Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Min Fang
- Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Jin Zhou
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, People's Republic of China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiaofeng Chen
- Department of Oncology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China
| | - Weiwei Pan
- Department of Cell Biology, College of Medicine, Jiaxing University, Jiaxing, People's Republic of China
| | - Fei Pang
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Yuxiang Zhou
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Qijie Jian
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Kai Wang
- Department of Medical, Shanghai OrigiMed Co, Ltd, Shanghai, People's Republic of China
| | - Liping Wang
- Department of Oncology, Baotou Cancer Hospital, Baotou, People's Republic of China
| | - Youcai Zhu
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Guocai Yang
- Department of Thoracic Surgery, Zhoushan Hospital, Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University(The First Affiliated Hospital of Guangzhou Medical University), Guangzhou, People's Republic of China
| | - Jing Cai
- Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Lijun Liang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Cancer Center, Zhejiang University, Hangzhou, People's Republic of China
| | - Huijing Feng
- Department of Thoracic Oncology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Lin Wang
- Department of Pathology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, People's Republic of China
| | - Yingying Du
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wang Yao
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xuefei Shi
- Department of Respiratory Medicine, Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, People's Republic of China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Dongmei Yuan
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yanwen Yao
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Jianhui Huang
- Department of Oncology, Lishui Municipal Central Hospital, Lishui, People's Republic of China
| | - Yinbin Zhang
- Department of Oncology, the Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Pingli Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Hong Wang
- Senior Department of Oncology, The 5th Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Mingxiang Ye
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Dong Wang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Zhaofeng Wang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yue Hao
- Department of Chemotherapy, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), Zhejiang, People's Republic of China
| | - Zhen Wang
- Department of Radiation Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Bing Wan
- Department of Respiratory Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Donglai Lv
- Department of Clinical Oncology, The 901 Hospital of Joint Logistics Support Force of People Liberation Army, Hefei, People's Republic of China
| | - Genhua Yu
- Department of Radiation Oncology, Zhebei Mingzhou Hospital, Huzhou, People's Republic of China
| | - Anna Li
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Jin Kang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Jiatao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
| | - Huafei Chen
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Lin Shi
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Leiguang Ye
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Gaoming Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yina Wang
- Department of Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Feng Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Zhou
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Chunxiu Hu
- Department of Cancer Radiotherapy and Chemotherapy, Zhejiang Queue Hospital, Quzhou, People's Republic of China
| | - Jianguo Wei
- Department of Pahtology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, People's Republic of China
| | - Bihui Li
- Department of Oncology, The Second Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Zhefeng Liu
- Senior Department of Oncology, The 5th Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Nong Yang
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Lin Wu
- Department of Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qiming Wang
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Wenbin Huang
- Department of Pathology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Zhuan Hong
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Guansong Wang
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Meiyu Fang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Xixu Zhu
- Department of Radiation Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Kaiqi Du
- Department of Thoracic Disease Diagnosis and Treatment Center, Zhejiang Rongjun Hospital, The Third Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Jiansong Ji
- Department of Radiology, Lishui Municipal Central Hospital, Lishui, People's Republic of China
| | - Yi Shen
- Department of Thoracic Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yiping Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Shenglin Ma
- Department of Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou Cancer Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yong Song
- Department of Respiratory Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Yuanzhi Lu
- Department of Clinical Pathology, The First Affiliated Hospital Of Jinan University, Guangzhou, People's Republic of China
| | - Anwen Liu
- Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, Guangzhou, People's Republic of China
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Current and Future Issues in the Surgical Treatment of Thymic Epithelial Tumors: a Review. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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19
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Wei B, Lu G, Zhang Y. Predictive factors for postoperative myasthenic crisis in patients with myasthenia gravis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivad040. [PMID: 36808486 PMCID: PMC9978318 DOI: 10.1093/icvts/ivad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/26/2023] [Accepted: 02/21/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Thymectomy plays an important role in the comprehensive treatment of myasthenia gravis. The present study aimed to investigate the risk factors for postoperative myasthenic crisis (POMC) in these patients and then establish a predicting model based on preoperatively available indicators. METHODS The clinical records of 177 consecutive patients with myasthenia gravis who received extended thymectomy between January 2018 and September 2022 in our department were retrospectively reviewed. Patients were divided into 2 groups according to whether they developed POMC. Univariate and multivariate regression analyses were conducted to identify the independent risk factors of POMC. Then a nomogram was constructed to intuitively show the results. Finally, the calibration curve and bootstrap resampling were used to evaluate its performance. RESULTS POMC occurred in 42 (23.7%) patients. By multivariate analysis, body mass index (P = 0.029), Osserman classification (P = 0.015), percentage of predicted forced vital capacity (pred%) (P = 0.044), percentage of predicted forced expiratory volume in the first second (pred%) (P = 0.043) and albumin to globulin ratio (P = 0.009) were identified as independent risk factors and entered into the nomogram. The calibration curve showed good concordance between the predicted and actual probability of prolonged ventilation. CONCLUSIONS Our model is a valuable tool for predicting POMC in myasthenia gravis patients. For those high-risk patients, appropriate preoperative treatment is necessary to improve the symptoms and greater attention to postoperative complications is needed.
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Affiliation(s)
- Bohua Wei
- Department of Thoracic Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Gaojun Lu
- Department of Thoracic Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
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20
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Robotic Mediastinal Surgery. Thorac Surg Clin 2023; 33:89-97. [DOI: 10.1016/j.thorsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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21
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Yang X, Wang S, Jiang J, Lin M, Gao J, Wang H, Tan L, Ding J. Comparison of the Perioperative Outcomes for Thoracoscopic Thymectomy Between the Subxiphoid Approach and the Lateral Intercostal Approach for Masaoka-Koga I-II Thymoma: A Propensity Score-Matching Analysis. Ann Surg Oncol 2023; 30:506-514. [PMID: 35838904 DOI: 10.1245/s10434-022-12059-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The appropriate approach for video-assisted thoracic surgery for early-stage thymoma remains debatable. The current study compared the safety and feasibility between subxiphoid-approach thoracoscopic thymectomy (SATT) and lateral intercostal-approach thoracoscopic thymectomy (LATT) for Masaoka-Koga stages 1 and 2 thymoma. METHODS The study retrospectively enrolled 461 patients without myasthenia gravis who underwent SATT or LATT at the Zhongshan Hospital of Fudan University between 2016 and 2020. A 1:1 propensity score-matching (PSM) analysis was performed to control for selection bias. A series of perioperative outcomes, including surgical outcomes, inflammatory factors, morbidity and mortality, pain assessment, and quality of life, were compared. RESULTS Each group consisted of 144 patients after PSM. The results showed that the SATT group had a significantly higher rate of exposure to the bilateral phrenic nerves (SATT [98.6 %] vs. LATT [77.1 %]; p < 0.001) as well as a larger maximum length (9.20 ± 3.08 vs. 7.52 ± 3.44 cm; p < 0.001) and width (6.13 ± 1.81 vs. 5.04 ± 1.77 cm; p < 0.001) of resected tissue than the LATT group. In addition, the SATT group had lower postoperative high-sensitivity C-reactive protein (hs-CRP) levels (9.37 ± 2.17 vs. 12.69 ± 2.13 mg/L; p < 0.001), better postoperative days 1, 3, and 7 visual analog pain scale (VAS) scores (p < 0.001), and better postoperative days 30 and 90 quality of life (p < 0.05). However, the two groups showed no significant increase in surgical time, estimated blood loss, total drainage time, postoperative total drainage volume, complications, or postoperative hospital stays. CONCLUSIONS The study results suggest that the SATT is feasible and safe for Masaoka-Koga stages 1 and 2 thymoma.
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Affiliation(s)
- Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jianyong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Rodriguez M, Milla L, Wee JO. The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:37. [PMID: 36582972 PMCID: PMC9792823 DOI: 10.21037/med-21-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/11/2022] [Indexed: 06/17/2023]
Abstract
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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Affiliation(s)
- Maria Rodriguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Lucia Milla
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Jon O. Wee
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, 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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Fu Y, Fu H, Lu Y, Lv X. The Effect of Ultrasound-Guided Low Serratus Anterior Plane Block on Analgesia and Quality of Recovery After Robot-Assisted Thymectomy via Subxiphoid Approach: Study Protocol for a Randomized Controlled Trial. J Pain Res 2022; 15:939-947. [PMID: 35411186 PMCID: PMC8994635 DOI: 10.2147/jpr.s359638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Study Design and Methods Discussion
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Affiliation(s)
- Yu Fu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Huimin Fu
- Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People’s Republic of China
| | - Yugang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Yugang Lu; Xin Lv, Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, People’s Republic of China, Tel/Fax +86 021 65115006, Email ;
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Galata C, Porubsky S, Dohle DS, Karampinis I, Stamenovic D, Roessner ED. Open redo thymectomy for a large recurrent thymoma in a patient with myasthenia gravis: a case report. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:8. [PMID: 35340829 PMCID: PMC8841549 DOI: 10.21037/med-21-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/13/2021] [Indexed: 06/14/2023]
Abstract
Thoracoscopic and robotic approaches are becoming increasingly popular for thymoma surgery. Yet open thymectomy must still be mastered today, as it may be the only viable option in challenging cases. In this study, we report a case of an extended local recurrence of myasthenia gravis associated thymoma and a history of previous sternotomy. The mediastinal mass infiltrated the left upper lobe of the lung, the pericardium, and presumably the aortic arch. Although the standard for thymoma resection at our institution is the robotic approach, we performed primary open redo thymectomy in standby of cardiopulmonary bypass in this case. Intraoperatively, bleeding from the aortic arch occurred, which was promptly controlled due to the open approach and due to immediate availability of cardiopulmonary bypass. The patient was transferred to the normal ward on the first postoperative day, was treated according to fast-track principles and recovered well. The pathology revealed a WHO B2:B1 thymoma with negative resection margins. Thymectomy is recommended as the principal treatment for thymoma and is also advised in the case of recurrence. However, there is no evidence regarding the optimal surgical approach. Our case indicates that in the era of minimally invasive thymectomy, the decision to conduct open surgery is wise when the risk of serious bleeding is anticipated or adherence to oncologic principles is challenged by tumor size or growth pattern.
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Affiliation(s)
- Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Sebastian Dohle
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric Dominic Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Acar K, Ersöz H. Comparison of Three Different Surgical Techniques in Patients Undergoing VATS and Open Thoracotomy. J Perianesth Nurs 2022; 37:479-484. [DOI: 10.1016/j.jopan.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/22/2021] [Accepted: 10/03/2021] [Indexed: 11/12/2022]
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Lv L, Li W, Men W, Liu Z, Jiang C. Comparing the safety and efficacy of thoracoscopic surgery and thoracotomy for thymoma: a systematic review and meta-analysis. Gland Surg 2021; 10:3378-3388. [PMID: 35070898 PMCID: PMC8749091 DOI: 10.21037/gs-21-786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/15/2021] [Indexed: 04/06/2024]
Abstract
BACKGROUND To systematically evaluate the efficacy of thoracoscopic surgery compared to traditional thoracotomy for thymic tumors. METHODS We performed a literature search on computer of the PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine (CBM), WanFang, and China national knowledge infrastructure (CNKI) databases from the date of establishment of the database to April 2021, and retrieved randomized controlled trials (RCTs) and cohort studies on thoracoscopic surgery and thoracotomy with conventional open thoracic surgery. After independent screening of the literature by two assessors, the relevant data was extracted and the risk of bias in the included studies was evaluated. RevMan 5.3 software was used to perform the analysis. RESULTS Five RCTs and eight cohort studies were ultimately included, with a total of 1,093 patients. The results of meta-analysis showed that compared with traditional thoracoscopic surgery, thoracoscopy had shorter surgery duration (OR =22.2, 95% CI: -31.92, -12.52, P<0.00001), ICU stay (OR =0.29, 95% CI: 0.20, 0.42, P<0.00001), and hospitalization time (OR =0.531, 95% CI: 0.41, 0.69, P<0.00001) times, as well as reduced chest tube drainage time (OR =0.49, 95% CI: 0.33, 0.73, P=0.0004), less intraoperative bleeding (OR =43.27, 95% CI: -50.94, -35.60, P<0.00001), and a lower incidence of postoperative complications (OR =0.19, 95% CI: 0.11, 0.34, P<0.00001). However, the tumor recurrence rate was not significantly different between the two procedures (OR =0.69, 95% CI: 0.32, 1.48, P=0.34). DISCUSSION The existing evidence suggests that thoracoscopic surgery has shorter surgery duration, ICU stay time, hospitalization time, reduced thoracic tube drainage, less intraoperative bleeding, and a lower incidence of postoperative complications compared with traditional thoracotomy surgery. However, due to the poor quality of the included research, more high-quality studies need to be conducted to verify the above conclusions.
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Affiliation(s)
- Ling Lv
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wanfu Men
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenghua Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chenggang Jiang
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
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Zervos M, Song A, Li Y, Lee SH, Oh DS. Clinical and Economic Outcomes of Using Robotic Versus Hand-Held Staplers During Robotic Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:470-476. [PMID: 34488486 DOI: 10.1177/15569845211040814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE During robotic lobectomy (RL), the surgeon can elect to use either robotic staplers or hand-held laparoscopic staplers. It is assumed that either will result in similar outcomes, while robotic staplers increase cost. We sought to compare perioperative outcomes and costs between RL cases that utilized robotic staplers versus hand-held staplers in real-world clinical practice. METHODS Patients who underwent an elective RL between October 2015 and December 2017 were identified in the Premier Hospital Perspective Database. Propensity score matching (PSM) analysis was performed to compare perioperative outcomes, healthcare resource utilization, and costs between cases using robotic staplers and hand-held staplers during RL. RESULTS In the PSM analysis, RL cases that fully utilized robotic staplers compared to hand-held staplers were associated with significantly lower risks of developing bleeding (5.6% vs 9.8%, P = 0.03) and conversion to open surgery (0.3% vs 5.9%, P = 0.004). Additionally, in a multivariable regression analysis, robotic stapler was associated with reduced risk for air leak (OR 0.70, 95% CI 0.50-0.98) and overall complications (OR 0.76, 95% CI 0.58-0.99). The total index hospitalization costs were comparable between the 2 groups (median [IQR], $21,667 [$16,860-$29,033] in robotic stapler vs $21,398 [$17,258-$29,406] in hand-held stapler, P = 0.22). CONCLUSIONS Among RL cases, utilization of robotic staplers was associated with significantly lower risks of perioperative bleeding, conversion, and possibly air leak and overall complications compared to RL cases utilizing hand-held staplers. The choice of stapler may have an impact on outcomes and robotic staplers do not increase total costs.
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Affiliation(s)
- Michael Zervos
- 12296 Division of Thoracic Surgery, Department of Surgery, New York University School of Medicine, NY, USA
| | - Alfred Song
- 10624 Department of Surgery, Stanford School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Yanli Li
- 19727 Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Shih Hao Lee
- 19727 Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Daniel S Oh
- 5116 Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan. Eur J Anaesthesiol 2021; 38:850-855. [PMID: 34226417 DOI: 10.1097/eja.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative respiratory failure is a serious problem in the anaesthetic management of patients with myasthenia gravis who undergo thymectomy. Although the classical recommendation is to avoid neuromuscular blockers, there is no strong evidence to support it. OBJECTIVES To evaluate the postoperative outcomes in patients with myasthenia gravis after thymectomy when anaesthetic management included rocuronium reversed with sugammadex. DESIGN A retrospective cohort study. SETTING Nationwide acute in-patient care database. PATIENTS A total of 1143 patients with myasthenia gravis who underwent thymectomy were included. Data were collected from the medical insurance claims data of acute care in-patient hospitals. MAIN OUTCOME MEASURES The postoperative complications when rocuronium reversed with sugammadex was compared against no muscle relaxant use using propensity score matching. The primary outcomes were the rates of in-hospital mortality, plasma exchange following thymectomy and the use of immunoglobulins. The secondary outcomes were the length of stay in the high dependency/ICUs, the total length of hospital stay and the duration and type of respiratory support following thymectomy. RESULTS There were no significant differences between the propensity score matched groups in terms of plasma exchange [relative risk, 0.96; 95% confidence interval (CI), 0.64 to 1.43] and use of immunoglobulins (relative risk, 1.09; 95% CI, 0.60 to 1.97). The length of hospital stay was significantly shorter in patients in whom rocuronium and sugammadex were used: 29.0 vs. 35.4 days, P = 0.035. CONCLUSIONS Anaesthetic management with rocuronium reversed by sugammadex was not associated with increased risk of respiratory complications. These findings could help in the anaesthetic management of patients with myasthenia gravis.
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Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg 2021; 113:904-910. [PMID: 34339670 DOI: 10.1016/j.athoracsur.2021.06.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/22/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is clinical equipoise regarding the perioperative and long-term outcomes of autoimmune myasthenia gravis (MG) patients undergoing open vs minimally invasive thymectomy, particularly for non-thymomatous MG. This analysis utilizes multicenter, real-world clinical evidence to assess perioperative complications of open and minimally invasive thymectomy techniques in MG patients. METHODS Thymectomy cases 2009-2019 in MG patients were identified in the Society of Thoracic Surgeons General Thoracic Surgery Database. Thymectomies were grouped by surgical technique: transthoracic (TT), transcervical (TC), video-assisted thoracoscopic surgery (VATS), or Robotic VATS (RVATS). Multivariable logistic regression models assessed the association between surgical technique and perioperative complications. RESULTS Analysis of non-thymomatous cases (n=1,725) revealed VATS (OR 0.44, CI 0.23-0.83), RVATS (0.73, 0.48-1.26) and TC (0.19, 0.06-0.62) had lower odds of perioperative complications than TT thymectomies. VATS (2.29, 0.63-8.30) and RVATS (4.08, 1.21-3.78) thymectomies had higher odds of perioperative complications than TC. Analysis of thymomatous cases (n=311) found no significant difference in the odds of perioperative complications in TT vs minimally invasive (VATS/RVATS) procedures. The proportion of RVATS procedures increased from 6.43% to 44.27% while TT (56.43% to 34.35%) and TC (19.29% to 6.87%) thymectomies decreased. CONCLUSIONS Minimally invasive and TC thymectomies have fewer perioperative complications than TT when performed for non-thymomatous MG. Minimally invasive procedures are increasingly performed for both non-thymomatous and thymomatous disease. There is a nationwide shift towards minimally invasive procedures, even for thymoma resections. Long-term neurological outcome data are needed to determine whether a reduced perioperative risk for minimally invasive thymectomies translates to improved MG outcomes.
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Affiliation(s)
- Shruti M Raja
- Department of Neurology, Division of Neuromuscular Medicine, Duke University Medical Center.
| | - Jeffrey T Guptill
- Department of Neurology, Division of Neuromuscular Medicine, Duke University Medical Center
| | - Alec McConnell
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine
| | - Matthew G Hartwig
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center
| | - Jacob A Klapper
- Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center
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Podobed AV, Kurchin VP, Bambiza AV, Savchenko OG, Malkevich VT. [Comparative analysis of thoracoscopic and open thymectomy for thymoma stage I-II]. Khirurgiia (Mosk) 2021:31-35. [PMID: 34270191 DOI: 10.17116/hirurgia202105131] [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: 11/17/2022]
Abstract
OBJECTIVE To improve the short-term postoperative outcomes in patients with thymoma stage I-II by using of thoracoscopic thymectomy (VATS TE) and to compare this technique with open (OTE) thymectomy. MATERIAL AND METHODS A retrospective analysis included 98 patients who had undergone surgery for thymoma stage I and II for the period from January 2001 to December 2019. VATS TE (main group) was performed in 53 (54.1%) cases, OTE (control group) - in 45 (45.9%) patients. RESULTS Duration of VATS TE and OTE was similar. VATS procedure was characterized by less intraoperative blood loss (50 vs 225 ml, p=0.000), lower pain scores and morphine consumption (p=0.000), shorter postoperative pleural drainage (1.5 vs 3.8 days, p=0.000), and postoperative hospital-stay (7.6 vs 12.7 days, p=0.000). Incidence of major complications was significantly less in the main group (9.4% vs. 1.9%, p=0.001). CONCLUSION VATS TE is effective and safe procedure for thymoma stage I-II. Postoperative period after VATS TE is characterized by less intraoperative blood loss, incidence of complications, duration of pleural drainage and hospital-stay.
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Affiliation(s)
- A V Podobed
- Alexandrov National Cancer Center of Belarus, Minsk region, Lesnoy, Belarus
| | - V P Kurchin
- Alexandrov National Cancer Center of Belarus, Minsk region, Lesnoy, Belarus
| | - A V Bambiza
- Alexandrov National Cancer Center of Belarus, Minsk region, Lesnoy, Belarus
| | - O G Savchenko
- Alexandrov National Cancer Center of Belarus, Minsk region, Lesnoy, Belarus
| | - V T Malkevich
- Alexandrov National Cancer Center of Belarus, Minsk region, Lesnoy, Belarus
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Kumar A, Asaf BB, Pulle MV, Puri HV, Sethi N, Bishnoi S. Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma. Eur J Cardiothorac Surg 2021; 59:807-813. [PMID: 33279991 DOI: 10.1093/ejcts/ezaa406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy. METHODS This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7 years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma. RESULTS Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P = 0.02, P = 0.04). Postoperative complications were significantly higher in the myasthenic group (P = 0.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22-3.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10-2.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2 years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09-2.71; P = 0.43). CONCLUSIONS The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Nitin Sethi
- Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Ancin B, Melih Ozercan M, Yilmaz Y, Uysal S, Kumbasar U, Dikmen E, Yilmaz M, Dogan R. Comparison of Early Postoperative Outcomes of Patients Undergoing Robot-Assisted and Transsternal Thymectomy. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Robot-assisted thoracoscopic surgery (RATS) is a minimally invasive technique that has been used in thymectomy operations in recent years. Minimally invasive surgical techniques offer less postoperative pain, a shorter length of hospital stay, and faster recovery compared to conventional surgical techniques. In our study, we aimed to compare the outcomes of robotic and transsternal thymectomies by analyzing the operative and postoperative data of these two approaches. Methods: Twelve robotic thymectomy patients and 16 transsternal thymectomy patients who were operated on in our clinic in 2018 were included in the study. Results: There was no significant difference between the two groups in terms of operative time (p=0.231). The median chest tube duration was 1.5 [range, 1-2] days in robotic thymectomy and 2.5 [range, 1-3.75] days in transsternal thymectomy. However, there was no statistically significant difference between the two groups (p=0.082). The amount of chest tube drainage was significantly lower in the robotic thymectomy group (p=0.006). The length of hospital stay was also significantly shorter in robotic thymectomy patients (p<0.001). Conclusion: The amount of chest tube drainage was lower and the length of hospital stay was shorter in the robotic surgery compared to the transsternal approach. There was no significant difference between the two techniques in terms of operative time. Within today's minimally invasive surgical techniques, robotic thymectomy can be considered a practical, comfortable, and safe technique with better early postoperative outcomes.
Keywords: Robot-Assisted Thymectomy, Thymectomy, Transsternal Thymectomy
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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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Holleran TJ, Napolitano MA, Crowder HR, Sparks AD, Antevil JL, Trachiotis GD. Clinical Outcomes and Technical Approach of Thymectomy in the Veterans Health Administration. Ann Thorac Surg 2021; 113:1648-1655. [PMID: 34087238 DOI: 10.1016/j.athoracsur.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thymectomy is traditionally performed via transsternal incision, but less invasive modalities have emerged, including transcervical, thoracoscopic, and robotic approaches. Despite the advantages of video-assisted thoracoscopic surgery(VATS) over thoracotomy, most thymectomies are performed via sternotomy. This study compared the utilization and 30-day post-operative outcomes of transsternal, transcervical, and VATS thymectomy in the Veterans Health Administration. METHODS This was a retrospective review of veterans that underwent thymectomy via the Veterans Affairs Surgical Quality Improvement Program. 30-day outcomes were compared between techniques, adjusting for confounding covariates. Temporal trends were analyzed using Spearman's rank correlation coefficient, rho(ρ). RESULTS From 2008-2019, 594 thymectomies were performed: 376(63.3%) transsternal, 113(19.0%) VATS(including robotic approaches), and 105(17.7%) transcervical cases. VATS utilization increased from 0% in 2008 to 61% of case volume in 2019. Relative to transsternal technique, VATS thymectomy was associated with decreased odds of pulmonary complications (adjusted odds ratio=0.06;p=0.028) and shorter hospital stay (2.9±0.4 days shorter;p<0.001). No difference in outcomes was detected between VATS and transcervical thymectomy. Post-operative complication rate decreased from 17.7% in 2008 to 5.6% in 2019 (ρ=-0.101;p=0.014). Length of stay decreased from median 4 days in 2008 to 3 days in 2019 (ρ=-0.093;p=0.026). In thymic cancer, VATS 5-year overall survival was non-inferior to transsternal approach(71.3% vs. 74.6%; p=0.54). CONCLUSIONS Transsternal approach comprised most thymectomy cases amongst veterans, while VATS thymectomy utilization increased over time and was associated with favorable outcomes. 30-day outcomes after thymectomy improved over time, which may reflect a trend towards wider utilization of less invasive approaches. Future studies should examine long-term outcomes.
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Affiliation(s)
- Timothy J Holleran
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC
| | - Hannah R Crowder
- Department of Surgery, George Washington University, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, George Washington University, Washington, DC
| | - Jared L Antevil
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC.
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Bergmann A, Schilling T. [Intraoperative Ventilation Approaches to One-lung Ventilation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:329-341. [PMID: 34038972 DOI: 10.1055/a-1189-8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The management of thoracic surgery patients is challenging to the anesthetist, since one-lung ventilation (OLV) includes at least two major conditions: sufficient oxygenation and lung protection. The first is mainly because the ventilation of one lung is stopped while perfusion to that lung continues; the latter is related to the fact that the whole ventilation is applied to only a single lung. Recommendations for maintaining the oxygenation and methods of lung protection may contradict each other (e. g. high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume, etc.). Therefore, a high degree of pathophysiological understanding and manual skills are required in the management of these patients.In light of recent clinical studies, this review focuses on a current protective strategy for OLV, which includes a possible decrease in FiO2, lowered VT, the application of positive end-expiratory pressure (PEEP) to the dependent and continuous positive airway pressure (CPAP) to the non-dependent lung and alveolar recruitment manoeuvres as well. Other approaches such as the choice of anaesthetics, remote ischemic preconditioning, fluid management and pain therapy can support the success of ventilatory strategy. The present work describes new developments that may change the classical approach in this respect.
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Park SY, Han KN, Hong JI, Kim HK, Kim DJ, Choi YH. Subxiphoid approach for robotic single-site-assisted thymectomy. Eur J Cardiothorac Surg 2021; 58:i34-i38. [PMID: 32061087 DOI: 10.1093/ejcts/ezaa036] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/23/2019] [Accepted: 01/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We previously reported a transthoracic approach using the da Vinci Single-Site™ platform. This study describes the outcomes of robotic single-site thymectomy via a subxiphoid approach based on our previous experiences. METHODS This study included patients, who underwent single-site robotic thymectomy via the subxiphoid approach between September 2018 and October 2019. A 3- to 4-cm vertical incision was made over the subxiphoid area, and the Lapsingle port with CO2 gas was introduced. After docking at the single site, a 5-mm curved cannula, 5-mm cardiere grasper and Maryland bipolar forceps or permanent cautery hook was inserted. The single-site robotic platform was used to conduct all surgical procedures except the dissection around the inferior portion of the thymic tissue performed via a thoracoscopic approach through the same incision. RESULTS Overall, 13 patients, including 2 with myasthenia gravis, were enrolled. The mean duration of the surgery and chest drainage were 167.3 ± 52.8 (range 73-253) min and 2.2 ± 0.9 (range 1-5) days, respectively. All surgeries were successfully completed without conversion to an open surgery, and there were no major post-surgical complications. The diagnoses based on histopathology included thymoma in 10 patients, thymolipoma in 2 patients and atypical carcinoid tumour in 1 patient with free resection margin. CONCLUSIONS This study demonstrated that robotic single-site-assisted thymectomy via the subxiphoid approach is a safe and technically feasible procedure. Although this initial series comprised relatively simple cases, more advanced and complex procedures can soon be performed with the advent of single-port robotic platform.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeong In Hong
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Planas G, Trujillo-Reyes JC, Guarino M, Martínez-Téllez E, Cladellas E, Pérez JI, Moral A, Belda J. What to do when the parathyroid gland is not found during a transcervical exploration? Interact Cardiovasc Thorac Surg 2021; 33:82-84. [PMID: 33893507 DOI: 10.1093/icvts/ivab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always be resected through a traditional cervical access. We present 2 cases of primary hyperparathyroidism who underwent an unsuccessful bilateral cervical exploration due to parathyroid tissue located inside the thymic gland. A video-assisted thoracoscopic surgery thymectomy with intraoperative determination of blood parathormone levels was performed. A 50% reduction of intraoperatory parathyroid hormone blood from the highest basal level at 5 and 10 min after resection was obtained. Final pathological results showed an intra-thymic parathyroid adenoma in the first patient and an intra-thymic focus of parathyroid hyperplasia in the second patient. In conclusion, video-assisted thoracoscopic surgery thymectomy could be the optimal approach to resect ectopic parathyroid adenomas located in the anterior mediastinum.
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Affiliation(s)
- Georgina Planas
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mauro Guarino
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Martínez-Téllez
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Esther Cladellas
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Ignacio Pérez
- Department of Endocrine and General Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Moral
- Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain.,Department of Endocrine and General Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Belda
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
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Vinh VH, Quang NVD, Thanh DDM, Van Le Phong T. Robotic video-assisted thoracoscopic surgery using multiport triangular trocar configuration: initial experience at a single center. J Cardiothorac Surg 2021; 16:77. [PMID: 33849581 PMCID: PMC8045230 DOI: 10.1186/s13019-021-01455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent developments in robotic technology have brought significant changes in robotic video-assisted thoracoscopic surgery (r-VATS) worldwide, particularly including the treatment in the thorax for the mediastinal, esophagus, and pulmonary lesions. Currently, there are only a few reports describing the procedural experience and outcomes with r-VATS. The objective of this study is to provide our initial experience using r-VATS at a single center, with specific attention to safety, efficacy, and procedural details. Methods We retrospectively reviewed patients who underwent a newly modified r-VATS procedure for various surgical operations at the thoracic department of our hospital, from July 2018 to January 2020. Multiport trocars were placed in the classic triangular arrangement as in conventional VATS (c-VATS) but with modifications based on the type of surgery. The peri- and postoperative outcomes such as duration of surgery, complications, and duration of hospital stay for these patients were reported. Results Overall, 142 patients underwent r-VATS for lobectomy (66), wedge resection (15), thymectomy (22), mediastinal tumor resection (30), pneumonectomy (4), transthoracic esophagectomy (1), esophageal tumor resection or esophageal diverticulum repair (2), diaphragm plication (1), and mediastinal tumor resection plus thymectomy (1). For the entire cohort, the median operative time was 110 min, and the median length of hospital stay was 5 days. Conversion to open thoracic surgery was reported only in a total of 3 (2.1%) patients of pneumonectomy (1.4%) and mediastinal tumor resection (0.70%). All our patients were managed successfully with no postoperative complications and mortality. Conclusion Our method of r-VATS was found to be safe and effective and may be applied to different surgical operations. Adequate and proper training of thoracic surgeons is immediately needed for the transition from c-VATS to r-VATS. The utility and advantages of triangular trocar configuration for r-VATS require further refinement and research before it can be routinely adopted in clinical practice. Trial registration Retrospectively registered.
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Affiliation(s)
- Vu Huu Vinh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam.
| | - Nguyen Viet Dang Quang
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Dang Dinh Minh Thanh
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
| | - Truong Van Le Phong
- Department of Thoracic Surgery, Choray Hospital, 202B Nguyen Chi Thanh Street, District No. 5, Hochiminh City, Vietnam
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Bhandarwar A, Jadhav S, Tandur A, Dhimole N, Wagh A, Bhondve S. Management of thymomatous myasthenia gravis - Case report of a rare Covid19 infection sequelae. Int J Surg Case Rep 2021; 81:105771. [PMID: 33744800 PMCID: PMC7954768 DOI: 10.1016/j.ijscr.2021.105771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction SARS CoV19 infection can predispose to many autoimmune and neurological conditions, thymomatous myasthenia gravis being one of them. The rarity of these case poses therapeutic dilemmas about their further management. Presentation of case A 61 year old gentleman who had covid19 infection 2 months back, presented with new onset myasthenia gravis and an anterior mediastinal mass. He was diagnosed as a case of anti acetyl choline receptor antibody positive thymomatous myasthenia gravis. The patient was posted for video assisted thoracoscopic excision of thymoma. The procedure was uneventful and patient was discharged with improvement in myasthenic symptoms. Histopathological examination confirmed the diagnosis of WHO Type A Spindle cell thymoma. Discussion SARS CoV19 infection is associated with an array of autoimmune disorders due to various proposed phenomenon including molecular mimicry and loss of immune tolerance. Post infectious thymomatous myasthenia gravis is extremely uncommon, and can be managed with open, minimally invasive or robotic approach. Conclusion This is the first documented case of post covid19 infection thymomatous myasthenia gravis to the best of our knowledge, managed with minimally invasive thoracoscopic surgery. Further research is required for documentation of the natural history of the disease and therapeutic outcomes.
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Affiliation(s)
- Ajay Bhandarwar
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Shekhar Jadhav
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Amarjeet Tandur
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Nikhil Dhimole
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India.
| | - Amol Wagh
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
| | - Supriya Bhondve
- Grant Medical College and Sir JJ Group of Hospitals, Byculla, Mumbai, 400008, India
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Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections? Curr Opin Anaesthesiol 2021; 34:199-203. [PMID: 33630772 DOI: 10.1097/aco.0000000000000975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. RECENT FINDINGS Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain. SUMMARY Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.
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Zeng L, Wang W, Han J, Zhu L, Zhao J, Tu Z. Uniportal video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery are feasible approaches with potential advantages in minimally invasive mediastinal lesions resection. Gland Surg 2021; 10:101-111. [PMID: 33633967 DOI: 10.21037/gs-20-536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to identify the feasibility of uniportal video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) compared with multiportal VATS in the resection of mediastinal lesions. Methods Patients who underwent mediastinal lesion resection were enrolled and allocated to the uni-VATS, tri-VATS, and RATS groups according to the surgical approach. Propensity score-matched (PSM) analysis was performed between the VATS and RATS groups as well as the uni-VATS and tri-VATS groups. The operative and recovery parameters were compared. Results Totally, 274 patients were enrolled. There was no difference in the operative parameters among the groups. Compared with multiportal VATS, uniportal VATS and RATS had a significantly shorter chest tube placement time (2.43±0.88 vs. 1.78±1.22 vs. 2.21±1.11 days, P<0.001) and hospital length of stay (LOS) (4.07±1.75 vs. 3.27±1.05 vs. 3.62±1.21 days, P=0.001) without increasing the incidence rate of complications (5.6% vs. 7.2% vs. 5.7%, P=0.864). After PSM, the RATS group showed a significantly lower unplanned conversion rate than the VATS group (0.0% vs. 8.2%, P=0.041), while the uni-VATS group had a shorter chest tube placement time (1.83±1.20 vs. 2.35±0.86 days, P=0.013) and hospital LOS (3.23±1.03 vs. 3.95±2.00 days) than the tri-VATS group. Conclusions Compared with multiportal VATS, uniportal VATS and RATS are technically safe and feasible with potential advantages for mediastinal lesion resection.
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Affiliation(s)
- Liping Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weidong Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia Han
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiangang Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhengliang Tu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Pro: thorakale Periduralanästhesie bei videoassistierter Thorakoskopie. Anaesthesist 2020; 69:758-759. [DOI: 10.1007/s00101-020-00841-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Su Z, Wu C, Bian H, Zhou Z, Jiang T, Zhao X, Liu F, Zhang Y, Lin K, Gao Q. Utilities and placement skills of the incision protective sleeve in video-assisted thoracoscopic surgery (VATS). J Thorac Dis 2020; 12:7272-7280. [PMID: 33447416 PMCID: PMC7797868 DOI: 10.21037/jtd-20-2703] [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] [Indexed: 11/22/2022]
Abstract
Background The incision protective sleeve can protect incisions and help to establish an operating port and thus has been widely applied in thoracic surgeries. However, its other utilities are often neglected. This article explores the additional functions and placement techniques of incision protective sleeves in video-assisted transthoracic surgery (VATS). Methods Operators with different surgical experience were divided into three groups: resident group, attending surgeon group, and professor group. Each group independently chose one of the four surgical maneuvers, and the incision protective sleeve was placed during the operation. Up to 200 operations were randomly selected in each group, and the patients’ gender, age, incision site, incision length, the operator’s experience, and the time and technique of incision protective sleeve placement were recorded. CT was performed to measure the thickness of chest wall and the width of intercostal spaces. Data were analyzed using SPSS 21.0 software package. Multivariate linear regression analysis was performed was performed for the time required for incision protective sleeve placement. Results The operator’s experience was inversely related to the time required for incision protective sleeve placement, width of intercostal spaces was negatively correlated with operative time, chest wall thickness and incision length were positively correlated with operative time. Among the maneuvers, incision protective sleeve placement skills were significant different. Conclusions The placement of the incision protective sleeve for VATS is affected by multiple factors, which are not only related to the patient’s condition, chest wall thickness and intercostal space, but also closely related to the operator’s experience and the manipulation adopted.
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Affiliation(s)
- Zhiyong Su
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Chao Wu
- Department of Obstetrics and Gynecology, Chifeng University Affiliated Hospital, Chifeng, China
| | - Hongliang Bian
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Zhiqiang Zhou
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Tianshuo Jiang
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Xin Zhao
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Fangchao Liu
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Yilei Zhang
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Keli Lin
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
| | - Qingshan Gao
- Department of Thoracic Surgery, Chifeng University Affiliated Hospital, Chifeng, China
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Kapriniotis K, Geropoulos G, Vianna T, Mitsos S, Panagiotopoulos N. Facilitating robotic thymectomy in patients with pectus excavatum deformity. Gen Thorac Cardiovasc Surg 2020; 69:618-620. [PMID: 33090363 DOI: 10.1007/s11748-020-01515-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
Robotic procedures in the anterior mediastinum can be challenging in the existence of pectus excavatum deformity due to the limited intrathoracic working space caused by sternal depression. We propose that the temporary application of a vacuum bell device during the procedure can correct the deformity and thus, facilitate robotic approach similarly to the standard procedure.
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Affiliation(s)
- Konstantinos Kapriniotis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK.
| | - Georgios Geropoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Thabbta Vianna
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Sofoklis Mitsos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G8PH, UK
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Rodriguez JA, Hooper G. Adenosine Triphosphate-Bioluminescence Technology as an Adjunct Tool to Validate Cleanliness of Surgical Instruments. AORN J 2020; 110:596-604. [PMID: 31774154 DOI: 10.1002/aorn.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Perioperative and sterile processing department personnel commonly use visual inspection to validate surgical instrument cleanliness. This validation process does not detect microbes (eg, bacteria, viruses) and the resultant inadequately decontaminated instruments can put patients at risk for developing surgical site infections. Sterile processing department personnel should use a rapid, straightforward method to validate surgical instrument cleanliness objectively. During a quality improvement project at a military treatment facility, staff members found that adenosine triphosphate (ATP)-based technology was a viable and affordable solution for detecting bioburden and validating cleaning practices. The project design compared manually and mechanically cleaned cannulated instruments (59 of each) and identified 16 contaminated instruments, 14 of which had been manually cleaned. The contamination rate after mechanical cleaning was significantly lower (P = .0022) compared with manual cleaning. As a result of this quality improvement project, this facility fully implemented the technology to validate instrument cleaning.
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Kumar A, Asaf BB, Pulle MV, Puri HV, Bishnoi S, Gopinath SK. Minimal Access Surgery for Thymoma. Indian J Surg Oncol 2020; 11:625-632. [PMID: 33281403 DOI: 10.1007/s13193-020-01208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Thymoma is a rare epithelial tumor of the thymus gland. Despite rarity, it is the most common tumor of the anterior mediastinum. Surgical resection in the form of extended thymectomy is the gold standard operation. Conventionally and even in the current era of significant advances in the minimally invasive surgery, open transsternal extended thymectomy is considered the gold standard, particularly for advanced-stage tumors. There is however significant evidence now available for the use of minimally invasive approaches for early-stage thymomas. This article aims to discuss the various minimally invasive approaches currently being employed for thymomas.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery and Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Srinivas Kodaganur Gopinath
- DNB Thoracic Surgery, Department of Thoracic Surgery and Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Rappaport JMP, Huang J, Ahmad U. Thymic Malignancy-Updates in Staging and Management. Surg Oncol Clin N Am 2020; 29:581-601. [PMID: 32883460 DOI: 10.1016/j.soc.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thymomas are relatively indolent tumors that present with locally advanced disease in 30% of the patients. Thymic carcinoma is a more aggressive histology with shorter disease-free and overall survival. Early-stage tumors are managed best with complete resection. Multimodal therapy is the standard of care for locally advanced tumors and neoadjuvant therapy may help improve respectability. Stage and complete resection are the strongest prognostic factors for long-term survival. Based on early experience, targeted and immunotherapies have shown limited promise in advanced disease.
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Affiliation(s)
- Jesse M P Rappaport
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Usman Ahmad
- Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA; Transplant Institute, Cleveland Clinic, Cleveland, OH, USA.
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Eichhorn M, Haag J, Grünewald C, Reimer P, Winter H. [Robot-assisted Mediastinal Mass Resection]. Zentralbl Chir 2020; 146:111-118. [PMID: 32767302 DOI: 10.1055/a-1192-7205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, robot-assisted thoracic surgery is gaining more and widespread interest in Europe. Due to the narrow space and the complexity of anatomical structures, conventional minimally invasive mediastinal surgery may be challenging for the thoracic surgeon. Robot-assisted mediastinal surgery opens up new possibilities for minimally invasive surgery, as it permits greater dexterity, a three-dimensional view, and tremor adjustment, which allows the surgeon to perform complex procedures in small thoracic spaces. As robotic platforms continue to evolve, more complex mediastinal thoracic surgical interventions will be facilitated, translating to improved outcomes for patients. This article provides an overview of the current status of robot-assisted mediastinal surgery and summarises general aspects of the indication, set-up and steps of robot-assisted thoracoscopic surgery in mediastinal mass resections.
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Affiliation(s)
- Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Johannes Haag
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Christiane Grünewald
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Peter Reimer
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Deutschland, Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL)
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Li XK, Xu Y, Cong ZZ, Zhou H, Wu WJ, Shen Y. Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: a propensity score matching study. J Thorac Dis 2020; 12:4033-4043. [PMID: 32944315 PMCID: PMC7475562 DOI: 10.21037/jtd-20-1065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Robotic system was recently introduced to assist surgeons in performing thymectomy. However, whether robot-assisted thoracoscopic thymectomy (RATT) could replace video-assisted thoracoscopic thymectomy (VATT) and be considered as a superior treatment for thymic epithelial tumors is still controversial. The aim of this study was to evaluate the progression-free survival (PFS) and short-term clinical outcomes in patients undergoing RATT or VATT by comparing the matched two groups after performing propensity score analysis. Methods We retrospectively reviewed the clinical data of 295 patients diagnosed with thymic epithelial tumors. There were 60 patients in RATT group and 235 in VATT group. Propensity score matching was done between two groups with variables of age, gender, tumor size, organization histologic classification, original Masaoka stages, presence of myasthenia gravis (MG) and adjuvant therapy. Sixty patients from the RATT group and 60 from the VATT group were matched, fitting the model. The PFS and short-term clinical outcomes of matched groups were compared. Results After matching, the surgical time in RATT groups was significant shorter than that in VATT groups (P=0.042). Loco-regional recurrence and distal metastasis were detected in 4 patients with thymoma and 1 patient with thymic carcinoma in RATT group and in 25 patients with thymoma and 3 patients with thymic carcinoma in VATT group before matching. PFS were estimated in only thymoma cases. The PFS in RATT group (n=55) intended to be longer than that in VATT group (n=58) after matching (5-year PFS rate: 81.5% and 75.4%, respectively; log-rank P=0.095). Conclusions RATT has the superiorities over VATT on short-term outcomes due to enabling surgeons to operate in a stable and comfortable environment. Meanwhile, RATT yielded a longer PFS compared with VATT, although the difference was not significant. Therefore, RATT could be considered as a standard approach for the treatment of thymic epithelial tumors.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hai Zhou
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
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