Background: Trans-subxiphoid thoracoscopic thymectomy is a promising procedure but technically demanding associated with ergonomic discomfort. In order to facilitate this complex procedure, the authors present a modified trans-subxiphoid thymectomy by the use of the Da Vinci robotic system.
Methods:A 2-cm longitudinal incision for camera was made below the xiphoid process. Through this incision, the space among the posterior surface of the sternum, bilateral mediastinal pleura and diaphragm (extra pleural space) was enlarged blindly with a finger. Additional two operation holes were created below bilateral costal arches, and then two 8-mm robotic trocars were inserted into the extra pleural space. A third robotic instrument was placed in the 5th intercostal space after bilateral mediastinal pleura were dissected.The whole thymus was excised for patients with thymic tumor, and simultaneous resection of surrounding adipose tissues was performed for patients with myasthenia gravis. Clinical characteristics and early surgical outcomes of the patients were retrospectively collected and analyzed. Results: Between August 2016 and September 2017, 70 consecutive patients with myasthenia gravis or thymic neoplasm were successfully treated by the described surgical procedure. The median overall operative time was 115 (range, 60-150) min. The median hospital stay was 5 (range, 4-7) days. The median duration of chest tube was 3 (range, 1-8) days. The blood loss was minimal for all the patients. There was no mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusions: Based on our preliminary experience, the described technique of thymectomy is safe and feasible, and provides an optimal access for the robot camera and the instruments. According to the description of Suda' paper, a conventional thoracoscopy must be used to open bilateral pleura before the robotic instruments reach the operative field in the anterior mediastinum. Herein, we introduce a modified procedure of robot-assisted trans-subxiphoid thymectomy which the whole operation can be completed by Da Vinci surgical system without the additional use of conventional thoracoscopy.
Methods
PatientsA total of 70 consecutive patients with myasthenia gravis or anterior mediastinal mass underwent robot-assisted trans-subxiphoid thymectomy during August 2016 and September 2017 in the Department of Thoracic Surgery, West China Hospital, Sichuan University. The operations were performed by a single surgical team experienced in both robotic surgery and trans-subxiphoid thoracoscopic thymectomy. The study protocol was approved by the applicable institutional review board. Written informed consents were obtained from all patients.Patients who were preoperatively diagnosed with resectable thymic neoplasms or myasthenia gravis were included in this study. Exclusion criteria: (I) patients had impaired cardiac, kidney, liver or lung function and had a great risk; (II) preoperative CT scan revealed that patients with advanced tumors...