Robotic thoracic surgery: The state of the art

Kumar, Arvind; Asaf, Belal Bin

doi:10.4103/0972-9941.147693

Cited by 63 publications

(52 citation statements)

References 62 publications

(70 reference statements)

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“…[24][25][26][27][28][29][30] Despite these positive results for robotic-assisted surgery in the mediastinum, thymectomy is still the most published operation of all robotic-assisted mediastinal resections; as of 2012, approximately 3,500 cases have been registered with Intuitive Surgical. 54 In addition, median sternotomy is considered the gold standard approach for thymus gland removal -a fact that could be due to the perceived increased cost associated with robotic surgery. However, some data suggest that robotic-assisted surgery costs less than videothoracoscopic surgery because of reduced length of hospital stays and the overall nursing care required.…”

Section: Posterior Mediastinummentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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Section: Posterior Mediastinummentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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“…Common possible findings are a thymic gland that extends under or lateral to the left phrenic nerve, or descends posteriorly to the brachiocephalic vein (19). Another critical point is represented by the position of the right phrenic nerve that is partially protected by the superior vena cava and may be easily identified in the lower part of the mediastinum (20,21).…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

“…Other authors prefer a right-sided thymectomy, describing an easier learning curve with this kind of approach, mainly because of a better ergonomic position to accomplish dissection and a larger operative field, due to the absence of the heart, but also an optimal visualization of the venous confluence and of the aortocaval groove (19,22,23).…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

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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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“…Por supuesto, los tiempos quirúrgicos prolongados y los altos costos que requiere este abordaje quirúrgico son algunos de los obstá-culos para una amplia aceptación de esta técnica. Se necesitan investigaciones adicionales en el campo de la enucleación de lesiones esofágicas por robot para recomendar esta práctica en comparación con otras técnicas mínimamente invasivas (17,19). En nuestro caso se ofreció a la paciente un abordaje asistido por robot por la ubicación de la lesión y el antecedente quirúrgico, en la que no se presentaron complicaciones intraoperatorias ni posoperatorias.…”

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Enucleación esofágica de leiomioma asistida por robot: reporte de caso y revisión de la literatura

Ramirez

Pereira

Miranda

2018

rev. colomb. neumol.

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Los leiomiomas esofágicos son tumores benignos resecados por enucleación esofágica cuando son mayores de 5 cm o en lesiones de cualquier tamaño que sean sintomáticas o con sospecha de malignidad. Tradicionalmente, la resección se ha realizado por técnica de enucleación abierta; sin embargo, la cirugía mínimamente invasiva surgió como una técnica con grandes ventajas, especialmente la tecnología robótica. Se reporta un caso de leiomioma esofágico del esófago medio con enucleación mediante el uso de una técnica de toracoscópica asistida por robot. La esofagoscopia intraoperatoria y transiluminación fueron complementos útiles para identificar el esófago y desarrollar un plano de disección extramucosa seguro que, junto con la asistencia robótica, parecen minimizar los riesgos intraoperatorios; entre ellos, la probabilidad potencial de lesión de la mucosa, así como también mejorar el tiempo de recuperación posoperatoria.Palabras clave: leiomioma esofágico, tumor benigno, robótica, enucleación, cirugía mí-nimamente invasiva, toracoscopia. AbstractEsophageal leiomyomas are benign tumors, which are resected by esophageal enucleation when they are larger than 5 cm, or in lesions of any size that are symptomatic or suspicious of malignancy. Resection has traditionally been performed by the technique of open enucleation; however, minimally invasive surgery has emerged as a technique with great advantages, and especially robotic technology seems to offer advantages. We report a case of esophageal leiomyoma of the middle esophagus with enucleation using a robot-assisted thoracoscopic technique. Intraoperative esophagoscopy and transillumination were useful adjuncts to identify the esophagus and to develop an extra mucosal dissection plane which with robotic assistance appear to minimize intraoperative risks among them, potentially the possibility of mucosal injury, and improving postoperative recovery time.

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Robotic thoracic surgery: The state of the art

Cited by 63 publications

References 62 publications

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Robotic thymectomy

Enucleación esofágica de leiomioma asistida por robot: reporte de caso y revisión de la literatura

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