Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis

Wu, Wenjie; Zhang, Fu-Yu; Xiao, Qiong; Li, Xiao-Kun

doi:10.1093/icvts/ivab109

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…Many studies have shown superior or equivalent outcomes of minimally invasive mediastinal surgeries in both short-and long-term follow-ups by comparing sternotomy to VATS or RATS and VATS with RATS (1,(5)(6)(7)(8)(9). Our team has also recently demonstrated the safety and feasibility of robotic single-site-assisted thymectomy (4) for reducing the number of incisions.…”

Section: Discussionmentioning

confidence: 99%

Biportal robotic surgery for anterior mediastinal mass

Hong¹,

Lee²,

Kim³

2023

Ann Cardiothorac Surg

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Background: Robotic-assisted surgery for mediastinal disease has been shown to be beneficial in facilitating easier mediastinal dissection with its three-dimensional views and multi-articulated moving instruments.Herein, we report our experience with the biportal approach of robot-assisted anterior mediastinal mass surgery, including both lateral transthoracic and subxiphoid approaches. Methods: We retrospectively analyzed 21 patients who underwent biportal robotic-assisted anterior mediastinal mass resection, without considering the tumor size between May 2018 and September 2022. We reviewed the technical advantages and limitations of the biportal approach and the perioperative outcomes, including operative time, conversion to multiport or open surgery, duration of chest drainage, and postoperative complications, to define the role of robot-assisted surgery using the biportal approach. Results: We approached the thoracic cavity from the right side in five patients, from the left side in three patients, and from the subxiphoid in 13 patients. Thymomas (n=13) and thymic cysts (n=3) were the most common diagnoses. The median operative time was 165 min [interquartile range (IQR), 140-196 min]. There were no conversions to multiport or open surgery. The chest drain was removed at a median of two days (IQR, 1-3 days), and the patients were discharged at a median of four days (IQR, 3-5 days).Perioperative complications were reported in two patients (one with prolonged air leak and one with vocal cord palsy). There were no cases of readmission or delayed complication. Conclusions:The biportal approach for robot-assisted surgery in anterior mediastinal masses is a feasible and safe alternative for treating associated pathologies. The subxiphoid approach for mediastinal surgery provides a better surgical view than the transthoracic approach. The biportal approach also enables the use of robotic staplers and energy devices and minimizes instrumental interference compared to that in the singleport approach.

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Section: Discussionmentioning

confidence: 99%

Biportal robotic surgery for anterior mediastinal mass

Hong¹,

Lee²,

Kim³

2023

Ann Cardiothorac Surg

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“…The pathological examination of the thymus following thymectomy has been identified as closely linked to the treatment outcome. Hyperplastic thymus has been associated with a higher rate of complete clinical remission (26,27) . However, in the study conducted by a study (20) , the pathology findings did not correlate with the treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Thymectomy in Myasthenia Gravis Patients

Sherif,

Aglan,

Abd-Ellatif

2023

Benha Medical Journal

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Background: Myasthenia gravis (MG) impairs voluntary muscle function by targeting the postsynaptic acetylcholine receptors, causing weakness and fatigue in the affected muscle group. This study aimed to assess the outcomes of thymectomy in MG patients, measure the extent of clinical improvement post-thymectomy by analysing changes in disease stage and medication needs, and identify prognostic factors that can aid in determining the most suitable patient selection. Methods: This prospective study was carried out on 53 patients aged greater than or equal to 18 years old, both sexes, scheduled for MG and underwent transsternal and VATS total thymectomy. Before surgery, each patient was evaluated by the neurologist and underwent a standard chest x-ray and a chest computed tomography. Both VATS and transsternal thymectomy were used as the surgical options in our study. Results: The majority of patients-who achieved full clinical remission-were classified under Osserman stages I, IIA, and III. In terms of the relationship between prognostic factors and complete clinical remission, females had a more favorable outcome following thymectomy (P-value = 0.019). Additionally, younger age was associated with better remission outcomes compared to older age groups (P-value < 0.001).Conclusions: Thymectomy is recommended for patients younger than 60 years with non-thymomatous, generalized AChR antibodyassociated myasthenia gravis. The early-onset MG, severe MG, female sex, and thymic hyperplasia are important factors helping to obtain better postoperative outcome. Thymectomy can reduce patient' s need for medication and the severity of MG regardless of age, sex, severity, or length of sickness, or thymic masses.

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“…Recently, Wu [28] compared results of robotic and VATS thymectomies, not identifying significant differences in terms of overall duration of the surgical procedure. O'Sullivan and co‐workers [6] found overall similar outcomes between RATS and VATS, while a more recent contribute [29] highlighted shorter length of stay and reduced complication rate in the RATS subgroup.…”

Section: Commentmentioning

confidence: 98%

Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

et al. 2023

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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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Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis

Cited by 8 publications

References 28 publications

Biportal robotic surgery for anterior mediastinal mass

Biportal robotic surgery for anterior mediastinal mass

Outcome of Thymectomy in Myasthenia Gravis Patients

Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

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