Robotic thymectomy

Wei, Benjamin; Cerfolio, Robert J.

doi:10.21037/jovs.2016.07.17

Cited by 15 publications

(6 citation statements)

References 11 publications

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“…In the present RST procedure, the surgical view is similar to that of median sternotomy, and safe dissection around the phrenic nerves is possible, even in patients with thymic tumours. The lateral approach, which is currently major, is often used for robot-assisted endoscopic thymectomy for thymic tumours and MG to allow easy recognition of mediastinal anatomy from the thoracic cavity [ 4 ]. It, however, might occasionally be insufficient to detect the opposite side of the phrenic nerve and of the upper polar of the thymus.…”

Section: Discussionmentioning

confidence: 99%

Robotic subxiphoid-optical thymectomy

Shimomura

Ishihara

Okada

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Robot-assisted thymectomy through a subxiphoid scopic approach can provide a good surgical view, similar to that of median sternotomy. We originally used the subxiphoid port only for the robotic scope to avoid instrument collision with the assistant device. This approach, robotic subxiphoid-optical thymectomy, is advantageous for the safe and accurate dissection of the bilateral phrenic nerves and the left brachiocephalic vein, which are especially needed in extended thymectomy for patients with myasthenia gravis.

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Section: Discussionmentioning

confidence: 99%

Robotic subxiphoid-optical thymectomy

Shimomura

Ishihara

Okada

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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“…Robotic thymectomy has come up in recent times due to the minimally invasive nature and its advantages, 2 and it also provides a new set of challenges for the anesthesiologist. Along with the neuromuscular blockade and reversal concerns, robotic thymectomy also has other considerations like patient positioning, minimal patient access after docking, capnothorax and resulting high airway pressures, and compression of the heart and major vessels during surgical dissection.…”

Section: Discussionmentioning

confidence: 99%

Perioperative challenges and neuromuscular blockade concerns in robotic thymectomy for myasthenia gravis

Pal

Gogia

Mehra

2020

Brazilian Journal of Anesthesiology (English Edition)

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“…At the discretion of her neurologist, she did not require IVIG treatment in advance of her operation. The patient was offered a thymectomy via right-sided robotic-assisted approach based on the location of the tumor on imaging [2].…”

Section: Case Presentationmentioning

confidence: 99%

Case report: cardiac herniation following robotic-assisted thymectomy

Espey

Acosta

Kolarczyk

et al. 2020

J Cardiothorac Surg

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Background: The first reported case of cardiac herniation was in 1948 and occurred following pericardiectomy during a lung cancer resection. Although rare, this potentially fatal surgical complication may occur following any operation in which a pericardial incision or resection is performed. The majority of literature on cardiac herniation involves case reports after intrapericardial pneumonectomy. Currently, there are no reports of cardiac herniation after thymectomy with pericardial resection. Case presentation: A 44-year-old Asian female with symptomatic myasthenia gravis was referred for thymectomy. Originally thought to have Bell's Palsy, her symptoms began with right eyelid drooping and facial weakness. Over time, she developed difficulty holding her head up, upper extremity weakness, difficulty chewing and dysarthria. These symptoms worsened with activity. She was found to have positive acetylcholine receptor binding antibody on her myasthenia gravis panel. A preoperative CT scan demonstrated a 3.5 cm × 2 cm anterior mediastinal mass along the right heart border and phrenic nerve. A complete thymectomy, via right-sided robotic-assisted approach was performed en bloc with a portion of the right phrenic nerve and a 4 cm × 4 cm portion of pericardium overlying the right atrium and superior right ventricle. Upon undocking of the robot and closure of the port sites, the patient became acutely hypotensive (lowest recorded blood pressure 43/31 mmHg). The camera was reinserted and demonstrated partial cardiac herniation through the anterior pericardial defect toward the right chest. An emergent midline sternotomy was performed and the heart was manually reduced. The patient's hemodynamics stabilized. A vented Gore-Tex 6 cm × 6 cm patch was sewn along the pericardial edges with interrupted 4-0 prolene to close the pericardial defect. Conclusion: This potentially fatal complication, although rare, should always be considered whenever there is hemodynamic instability entry or resection of the pericardium during surgery. We now routinely sew in a pericardial patch using our robotic surgical system for any defect over 3 cm × 3 cm that extends from the mid-to inferior portions of the heart.

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Robotic thymectomy

Cited by 15 publications

References 11 publications

Robotic subxiphoid-optical thymectomy

Robotic subxiphoid-optical thymectomy

Perioperative challenges and neuromuscular blockade concerns in robotic thymectomy for myasthenia gravis

Case report: cardiac herniation following robotic-assisted thymectomy

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