Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis?

Toker, Alper; Erus, Suat; Özkan, Berker; Ziyade, Sedat; Tanju, Serhan

doi:10.1510/icvts.2010.254599

Cited by 28 publications

(22 citation statements)

References 14 publications

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“…Thymic tumor size mass has frequently been used as a determinant to select patients for minimally invasive or open thymectomy. Earlier studies with the thoracoscopic VATS approach for thymectomy suggested safe resections for thymomas up to 3 cm [6,15]. Kimura and colleagues [9] demonstrated that for the VATS approach, larger tumors (>5 cm) substantially increased operative risk with a chance of capsular injury.…”

Section: Commentmentioning

confidence: 99%

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Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Kneuertz

Kamel

Stiles

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

“…There is a substantial learning curve associated with robotic-assisted procedures for mediastinal pathologic characteristics [15,16]. This is important to recognize because the popularity of the robotic approach is growing and more centers are adopting this technique.…”

Section: Commentmentioning

confidence: 99%

Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Kneuertz

Kamel

Stiles

et al. 2017

The Annals of Thoracic Surgery

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“…Historically, clinicians have been averse to use minimally invasive techniques for thymic tumors, both because of the supposed risk of rupture of the tumors' capsule during the manipulation of the lesion with the endoscopic instruments and the possibility of reduced safety margins with an increased probability of local recurrence (25)(26)(27).…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

“…The majority of the authors consider acceptable lesions smaller than 5 cm (21,25). Larger tumor's dimension, while not being an absolute contraindication, could make manipulation more difficult and interfere with the thoracoscopic procedure, prolonging the operative time, increasing the chance of an open conversion and the risks of tumor's rupture and spreading (21).…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

Robotic thymectomy

Marulli¹,

Comacchio²,

Rea³

2017

J. Vis. Surg.

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Thymectomy is the most frequent surgical operation involving the mediastinum, both for the treatment of thymic tumors and for the multidisciplinary management of myasthenia gravis (MG). Different surgical approaches have been described, either traditional open approaches or minimally invasive ones.Robotic thymectomy represents a further step in the evolution of minimally invasive surgery. Available data show that robotic thymectomy may be considered a safe and feasible operation, with encouraging long-term results in myasthenic patients and promising results in patients with early stage thymoma, both in terms of surgical and oncological outcomes. We present the surgical technique of robotic thymectomy that we apply for patients affected by myasthenia gravis and early stage thymoma. that could be related to MG and to evaluate the serum titer of antibodies against acetylcholine-receptor. If negative, anti-MuSK (muscle specific receptor tyrosine kinase) antibodies should be tested; there is evidence that a positive serum titer of anti-MuSK Ab is predictive of a lesser effect of thymectomy on MG symptoms (14).Anyway, neurological assessment prior to surgery should be always performed to evaluate presence of active or significant symptoms of MG or to optimize the medical treatment. Particularly, the levels of corticosteroids should be decreased, prior to surgery. The risk of post-operative respiratory failure may be reduced by preoperative intravenous immunoglobulin administration or plasmapheresis, particularly in patients with partiallycontrolled symptoms (15,16).Regarding timing for surgery, there isn't a gold standard, but it seems that an early removal of the thymic gland may improve the remission rate (16). Age over 50 years or antibody-negative disease are relative contraindications to thymectomy in nonthymomatous MG (17,18).Moreover, all patients should be evaluated with a contrast-enhanced CT scan of the chest. Magnetic resonance and/or PET-CT scan can also be performed in the suspicion of thymoma or to distinguish between a thymic hyperplasia and a small thymoma.Pre-operative chest X-rays should be performed to evaluate signs of extensive adhesions, related to prior pleuritis or thoracic surgical procedure, which may preclude a robotic approach.Functional assessment should be completed with pulmonary function tests, complete blood examination and electrocardiogram. Pre-operative preparationThe operation is performed under general anesthesia and the patient is ventilated through a double-lumen endotracheal tube. During procedure, patients are monitored by ECG, arterial line, pulse oximeter and urine output.The patient is placed left or right-side up (based the side of operation), at a 30-degree angle with a bean bag. In leftsided approaches, the left arm is placed parallel to the bed while the right arm is positioned along the body to expose the axillary region (opposite for right-side operations). In the operating room the surgeon console is positioned away from the patient while the video column ...

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“…Although in the last decades minimally invasive surgery has greatly developed in different oncological fields, several surgeons have been reluctant to use these surgical approaches for early stage thymoma 48…”

Section: Thymoma and Thymectomymentioning

confidence: 99%

Robotic-assisted thymectomy: current perspectives

Marulli

Comacchio

Stocca

et al. 2016

RSRR

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Thymectomy is the cornerstone in the treatment of thymic tumors and an accepted option for the management of myasthenia gravis. Different surgical approaches have been described, but the gold standard is represented by median sternotomy. In the last two decades, the development of minimally invasive surgery has led to an increased acceptance of thymectomy, especially for benign diseases. Robotic thymectomy seems a further step in the development and evolution of minimally invasive approaches. Since its introduction, different authors described their experience with robotic thymectomy, both for nonthymomatous myasthenia gravis and for thymic tumors. Available data show that robotic thymectomy may be considered a safe and feasible operation. In patients with nonthymomatous myasthenia, robotic thymectomy is effective and the long-term results are encouraging. The role of robotic thymectomy in patients affected by thymoma is still under evaluation, but the intermediate results seem promising both in terms of surgical and oncologic outcomes.

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Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis?

Cited by 28 publications

References 14 publications

Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison

Robotic thymectomy

Robotic-assisted thymectomy: current perspectives

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